Method and system for quantitative assessment of visual contrast sensitivity

ABSTRACT

A method is presented to address quantitative assessment of visual contrast sensitivity in a subject, where the method comprises the steps of: ( 1 ) presenting at least one scene to the subject on a display, the scene comprising a plurality of elements and a background; ( 2 ) modulating the contrast of at least one element; ( 3 ) receiving feedback from the subject via at least one input device; ( 4 ) quantitatively refining the received feedback relative to the scene; ( 5 ) adjusting the contrast relative to accuracy of the quantitatively refined feedback; ( 6 ) calculating a critical threshold parameter for the subject; and ( 7 ) recording a critical threshold parameter onto a tangible computer readable medium. An apparatus for quantitative assessment of visual contrast sensitivity of a subject comprising a display device, an input device, a control device, and a tangible computer readable medium. In its simplest sense, quantitative assessment profile of visual contrast sensitivity by psychophysical responses is generated on a tangible computer readable medium.

TECHNICAL FIELD

This disclosure relates in general to the field of psychophysics, andmore particularly to perceptual abnormalities associated with sensoryand motor processing, and even more particularly to quantitativeassessment of functional impairment.

BACKGROUND

Substantial literature exists describing cognitive and visualimpairments due to neural dysfunctions, neurodegenerative diseases, andmental disorders. Visual functions, such as shape and motion processing,are impaired by neural dysfunctions. However, many visual abnormalitiesare unlikely to be uncovered during routine neurological examination.

A method and system for quantitative assessment of functional impairmentenables for detection of and indicates diagnosis of a variety ofneurological diseases and disorders. A system for sensory-motorquantitative neurocognitive assessment provides continuous feedbackadjusted stimulation and its standardized scoring algorithms may providefor diagnosis for early stages of cognitive changes and visualimpairments associated with a variety of neurological diseases anddisorders. Quantitative assessment may aid in the investigation ofcognitive and visual functions at various levels, including, but notlimited to, contrast sensitivity, motion detection, depth recognition,and object recognition.

Further, quantitative assessment may indicate diagnosis of neurologicaldiseases and disorders, which include Alzheimer's Disease, Parkinson'sDisease, autism, depression, schizophrenia, Asperger's Syndrome,Williams Syndrome, among others. Alzheimer's Disease and Parkinson'sDisease are the most common neurodegenerative diseases. Autism anddepression are among the most common mental disorders.

Alzheimer's Disease is characterized pathologically by synapticdysfunction and clinically by a decline in memory and cognition.Further, Alzheimer's Disease may be accompanied by attentional andperceptual deficits, including impaired visual motion and processing.Research studies suggest a perceptual basis of visuospatialdisorientation in Alzheimer's Disease. Further, attentional dynamics inAlzheimer's Disease may limit the rate at which visual motion signalscan be integrated into a coherent representation of self-movement.Alzheimer's Disease can begin with a wide variety of different symptomsand progresses through recognized clinical stages to include anincreasing number of symptoms and worsening functional disability;research studies have demonstrated that all of these changes areaccompanied by substantial impairments of perceptual-motor processing.

Currently, Alzheimer's Disease has no cure or preventive therapies, onlysymptomatic treatments. Diagnosis is usually be established withbehavioral assessments and cognitive tests, often followed by one ofmore types of brain imaging. Researchers have known that Alzheimer'sDisease is characterized by impairments in memory deficit and visualfunctions. Visual impairments in Alzheimer's Disease most commonly occurin motion, depth of field, color, and contrast.

Parkinson's Disease is a neurodegenerative disorder that impairs motorskills, speech, and thought processes, among other functions.Parkinson's Disease may be diagnosed based on clinical evaluations thatreveal limb and truncal rigidity, tremor, and a slowing of physicalmovement and mental events. Non-motor symptoms may include autonomicdysfunction, cognitive abnormalities, sleep disorders, and sensoryabnormalities. All of these symptoms are thought to the result ofdecreased stimulation of the cerebral areas caused by the insufficientformation and action of dopamine.

In addition, people with Parkinson's Disease usually develop somemanifest eye movement control and visual processing problems, such asstare because they do not blink as frequently as before, and aninability to respond to visual motion cues that guide posturalstabilization reflexes. The eyes may also have trouble fixating onobjects and following objects as they move. Parkinson's Disease mayimpair visual processing and cause symptoms including reduced vision,poor color vision, and difficulties in appreciating the correct locationor orientation of an object.

Autism is a brain developmental disorder that is characterized bywidespread abnormalities of social interactions and communication.Individuals with autism also have difficulty with processing andresponding to sensory information and use visual informationinefficiently. Autistic people may have difficulty maintain visualattention and frequently rely on constant scanning of visual informationin order to gain meaning, especially in the domain of social cues. Theirsymptoms reflect their inability to integrate their central andperipheral vision.

Eye movement disorders are common in Autism, but the most prominentvisual symptom in autism is the aberrant local and global processingcharacterized by a superior perception of fine details. Another symptomin autism may be the impaired motion perception that may be also linkedto abnormal perceptual integration.

Schizophrenia is a disabling brain disorder characterized byabnormalities in the perception of expression or reality. Much work inthe cognitive neuroscience of schizophrenia has focused on attention andmemory; however, perceptual functions and visual processing aresubstantially disrupted in schizophrenia. Schizophrenia may generallyassociated with deficits in higher-order processing of visualinformation at a cognitive level. Deficits in contrast sensitivity formoving and static gratings, from discrimination in noise and dot motiondiscrimination have also been reported in patients with schizophrenia.

People with schizophrenia fail to use contextual information todisambiguate visual information. Poor form processing, particularlyobject recognition, grouping, perceptual closure, contour integration,face processing, and reading are typically present in people withschizophrenia.

Asperger's Syndrome is an autism spectrum disorder. People withAsperger's Syndrome may show significant difficulties in socialinteraction, along with other restricted and repetitive patterns ofbehavior and interests. Asperger's Syndrome may differ from other autismspectrum disorders by its relative preservation of linguistic andcognitive development. However, physical clumsiness and atypical use oflanguage may have been frequently reported. Asperger's Syndrome maybegin in infancy or childhood, may have a steady course of declinerelative to the age-matched cohort with impairments that may result frommaturation-related changes in various systems. However, individuals withAsperger's Syndrome may have excellent basic auditory and visualperception despite impaired higher-order processing of emotional andsocial signals.

Williams Syndrome is a rare neurodevelopment disorder that may be causedby a deletion of about twenty-six genes from the long arm of chromosomeseven. Williams Syndrome may be characterized by a distinctive elfinfacial appearance, along with a low nasal bridge; an unusually cheerfuldemeanor and easer with strangers; mental retardation coupled withunusual language skills; a love for music; and cardiovascular problems,such as supravalvular aortic stenosis and transient hypercalcaemia.Further, individuals with Williams Syndrome may have problems withvisual processing, which may be related to difficulty in dealing withcomplex spatial relationships rather than to issues with depthperception.

In many neural dysfunctions the cognitive capabilities are primarilyaffected; however, vision is impaired to some degree. The prevalence ofbasic visual defects raises naturally the question of their impact oncognitive functions and suggests that some cognitive impairments resultdirectly or indirectly from deficiencies at a perceptive level ratherthan from a core cognitive problem. Hence cognitive impairments andvision impairments can be linked.

Brain imaging techniques and brain-scanning devices have been widelyused in investigating cerebral functions and neuro-chemical changes;however, they are of little use in quantifying deficits in visualfunctions and are burdensome and cost-prohibitive when used to regularlymonitor the progress of neurodegenerative disease and mental disorders.

Other tools, such as behavioral assessments and cognitive tests,although cost effective, have drawbacks since they are only adequate forobtaining a qualitative assessment of the visual deficits. Such paperand scoring tests, when given as a sequence of tests, do not considerthe results of the initial tests in subsequent tests.

Additionally, since cognitive and sensory impairments are not widelyrecognized as closely linked, sensory-cognitive testing is not conductedat the same medical visit. Thus, a need exists, therefore, fordeveloping appropriate perceptual tests to quantify the impact of theneural diseases on the affected visual functions.

Further, although some consider behavioral analysis to not bequantifiable, many research studies indicate that functional impairmentcan indeed analyzed in a quantitative fashion. Thus, a further needexists for an improved system for quantitative assessment of functionalimpairment to treat subjects with cognitive, perceptual, neurological,visual, and/or attentional deficiencies.

Yet a further need exists to overcome the problem of identifying theearly phases of the neural disease or disorder.

A further need exists to overcome the problem of monitoring neuraldisease progress.

Yet a further need exists for a system for quantitative assessment offunctional impairment that has the ability to simplify clinical researchon cognitive, perceptual, neurological, visual, and/or attentionaldeficiencies.

Still further improvement is needed in animal research evaluationswherein varying scene patterns are shown to animal subjects.

Yet a further need exists for laboratories of drug companies andpharmaceutical companies to research and develop treatments forneurological impairment testing of subjects.

Still further improvement is needed to identify meta-parameters that maycause functional impairment and methods to diagnose their exemplarydiseases and disorders.

A further need exists to generate real-time scores and diagnosis basedon quantitative assessment of functional impairment.

Still further improvement is needed in critical testing of memory,attention, emotional, and social cue analysis.

A need exists for a treatment of development processes that may causefunctional impairment in subjects.

Yet a further need exists for maximizing stimulus response compatibilityin assessment of functional impairment so as not to obscure aspects ofsensory processing and motor control.

Still further improvement is needed in a functional impairmentassessment tool that captures all aspects of sensory input, cognitivetransformation, and motoric response.

Further, a need exists for the incorporation of artificial intelligencein assessment of functional impairment.

Finally, a need exists for dynamic testing in clinical research, whereina system responds to the actions of a subject.

BRIEF SUMMARY OF THE INVENTION

The present invention relates to a method for quantitative assessment offunctional impairment in a subject, where the method presents scenes toa subject, determines an equilibrated scene parameter of a subject, andgenerates information that may substantially contribute to a diagnosis.More concretely and with the example of diagnosed functional impairment:A recommended medical intervention, including but not limited to, drugs,medicinal supplements, behavioral programs, and surgical treatments. Inone aspect, an apparatus for quantifying assessment of functionalimpairment in a subject comprising an input device, a display device, acontrol device, and a tangible computer readable medium. In anotheraspect, a system of tests for functional impairment tests continuouslymodulates specific perceptual domains on a stimulus and transitionsacross perceptual domains in manner to measure the response errorrelative to a predetermined threshold. In its simplest sense, anassessment profile of functional capacity by psychophysical responses isgenerated on a tangible computer readable medium. The present disclosureimproves and simplifies complex experimental paradigms in the context ofpsychophysical and electrophysiological studies of spatial or temporalaspects of assessment of functional impairment.

In accordance with the disclosed subject matter, the quantification ofthe impact of neural diseases onto affected visual functions isprovided, thereby substantially reducing problems associated withidentifying the early phases of neural diseases and neural disorders, aswell as with secondary and tertiary prevention. A need exists fordeveloping appropriate perceptual tests to better understand perceptualdeficiencies. The present disclosure teaches a plurality of testscomprising a series of scenes. More specifically, the present disclosuregenerates and presents complex dynamic scenes, collects responses from asubject, quantitatively refines results, calibrates a display devicerelative to the interpreted feedback, and determines a diagnosis andmedication to a subject.

These and other advantages of the disclosed subject matter, as well asadditional novel features, will be apparent from the descriptionprovided herein and from the attached figures. The intent of thissummary is not to be a comprehensive description of the claimed subjectmatter, but rather to provide a short overview of some of the subjectmatter's functionality.

BRIEF DESCRIPTION OF DRAWINGS

The present subject matter will now be described in detail withreference to the drawings, which are provided as illustrative examplesof the subject matter so as to enable those skilled in the art topractice the subject matter. Notably, the figures and examples are notmeant to limit the scope of the present subject matter to a singleembodiment, but other embodiments are possible by way of interchange ofsome or all of the described or illustrated elements and, further,wherein:

FIG. 1 shows a conceptual framework of the interacting subsystems in theenvironment that is used to assess functional impairment in a subject;

FIG. 2 displays a workflow of running the method to assess functionalimpairment in a subject;

FIG. 3 depicts a test environment, including a mounted shroud-boxenclosure that may shield the subject from visual distractors.

FIG. 4 shows the computing system used that may be used in thequantitative assessment of functional impairment.

FIG. 5 shows the paradigm of a hierarchical nature of parametricindividualization;

FIG. 6 portrays a representation of left posterior-lateral view of thehuman brain;

FIG. 7 display an exemplary operator display;

FIG. 8 illustrates an embodiment of the principal components of thepresently disclosed method for assessment of functional impairment;

FIG. 9 shows a rotary manipulandum device that may support the presentlydisclosed method for assessment of functional impairment;

FIG. 10 presents a linear manipulandum device that may support thepresently disclosed method for assessment of functional impairment;

FIG. 11 shows a xy Catersian manipulandum that may support the presentlydisclosed method for assessment of functional impairment;

FIG. 12 portrays a block diagram of a stimulus generator that combineshardware and software to produce a scene parameter;

FIG. 13 shows a block diagram of the subject manipulandums that maysupport the presently disclosed method for assessment of functionalimpairment;

FIG. 14 portrays an exemplary operator output interface;

FIG. 15 depicts a power user preset controls for visual movement module,which may serve as a graphical user interface with parameter adjustmentsliders and buttons in the operator display;

FIG. 16 presents a graphical user interface for a subject demographicsentry display;

FIG. 17 shows an exemplary subject medical history entry display;

FIG. 18 illustrates an exemplary standard operations test scoringdisplay;

FIG. 19 shows an exemplary standard operations dynamic performancedisplay;

FIG. 20 illustrates an exemplary operator comments entry display;

FIG. 21 presents the system initiation sequence and the test initiationsequence of the testing flow process for the conceptual framework forquantitative assessment;

FIG. 22 illustrates a sequence of test control steps and a sequence oftest presentation steps;

FIG. 23 displays the process flow of test sequencing and test closing;

FIG. 24 portrays the sequences of steps for data archiving, operatorinterface, and accounts management;

FIG. 25 shows starting phase of the dynamic contrast test;

FIG. 26 illustrates the intermediate phase of the dynamic contrast test;

FIG. 27 displays the termination phase of the dynamic contrast test;

FIG. 28 shows starting phase of the visual contrast sensitivity test;

FIG. 29 illustrates the intermediate phase of the visual contrastsensitivity test;

FIG. 30 displays the termination phase of the visual contrastsensitivity test;

FIG. 31 portrays the starting phase of the visual motion discriminationtest;

FIG. 32 shows the intermediate phase of the visual motion discriminationtest;

FIG. 33 illustrates the termination phase of the visual motiondiscrimination test;

FIG. 34 depicts the initiation of the visual motion discrimination test;

FIG. 35 shows the intermediate phase of the visual motion discriminationtest;

FIG. 36 illustrates the termination phase of the visual motiondiscrimination test;

FIG. 37 depicts the superposition of form and motion tests;

FIG. 38 illustrates the intermediate phase of the spatial attentioneffects test;

FIG. 39 represents the left-up form target and right-up motion target ofthe visual motion and visual form attention test;

FIG. 40 displays the left-up form, low-distinct target and right-upmotion, high-coherence target of the visual motion and visual formattention test;

FIG. 41 shows the left-up form, high-distinct target and right-upmotion, low-coherence target of the visual motion and visual formattention test;

FIG. 42 portrays the left-up form, high-distinct target and right-upmotion, high-coherence target of the visual motion and visual formattention test;

FIG. 43 displays the starting phase of the word recognition module;

FIG. 44 shows normal letters orientation;

FIG. 45 shows mirror rotated letters orientation;

FIG. 46 shows inverted letters orientation;

FIG. 47 shows the intermediate phase of the word recognition module;

FIG. 48 shows the termination phase of the word recognition module;

FIG. 49 illustrates the starting phase of the verbal memory module;

FIG. 50 displays the intermediate phase of the verbal memory module;

FIG. 51 illustrates the left-up target orientation with high contrast;

FIG. 52 shows the right-up target orientation with moderate contrast;

FIG. 53 displays the right-down target orientation with low contrast;

FIG. 54 shows a low difficulty facial emotion sensitivity test;

FIG. 55 shows a moderate difficulty facial emotion sensitivity test;

FIG. 56 shows a high difficulty facial emotion sensitivity test;

FIG. 57 shows a low difficulty facial emotion nulling test;

FIG. 58 shows a moderate difficulty facial emotion nulling test;

FIG. 59 shows a high difficulty facial emotion nulling test;

FIG. 60 illustrates the low difficulty social cues sensitivity test;

FIG. 61 illustrates the moderate difficulty social cues sensitivitytest;

FIG. 62 illustrates the high difficulty social cues sensitivity test;

FIG. 63 shows an exemplary position trace;

FIG. 64 illustrates an exemplary speed trace;

FIG. 65 depicts an exemplary acceleration trace;

FIG. 66 displays an exemplary 3D S/N Gradient;

FIG. 67 portrays an exemplary S/N profile with respect to vertical andhorizontal positions;

FIG. 68 shows an exemplary position error function profile;

FIG. 69 shows an exemplary sampled position error function profile;

FIG. 70 displays an exemplary velocity error function profile;

FIG. 71 portrays the instantaneous position error;

FIG. 72 shows a graphical representation of the error magnitudethroughout test;

FIG. 73 depicts the stimulus obscuration over time;

FIG. 74 displays the subject position error relative to target position;

FIG. 75 illustrates depicts the subject velocity error relative totarget velocity; and

FIG. 76 shows a results summary via a graphical user interface.

FIG. 77 provides an exemplary recommended diagnosis summary.

DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS

The present disclosure is related to the subject matter disclosed in thefollowing co-pending applications filed on Sep. 16, 2009 and each namingCharles Joseph Duffy as the inventor: Ser. No. 12/560,583 and entitledMETHOD AND SYSTEM FOR QUANTITATIVE ASSESSMENT OF FUNCTIONAL IMPAIRMENTand Ser. No. 12/560,605 and entitled METHOD AND SYSTEM FOR QUANTITATIVEASSESSMENT OF VISUAL MOTOR RESPONSE.

In describing embodiments of the present invention illustrated in thedrawings, specific terminology is employed for the sake of clarity. Inthe present specification, an embodiment showing a singular componentshould not be considered limiting. Rather, the subject matterencompasses other embodiments including a plurality of the samecomponent, and vice-versa, unless explicitly stated otherwise herein.Moreover, applicant does not intend for any term in the specification orclaims to be ascribed an uncommon or special meaning unless explicitlyset forth as such. Further, the present subject matter encompassespresent and future known equivalents to the known components referred toherein by way of illustration.

A more full understanding regarding the field of this disclosed subjectmatter appears in the following patents, all of which have commonassignment and inventorship by Charles Joseph Duffy and all of which areincorporated by reference in their entirety for all purposes into thisdetailed description: U.S. Application No. U.S. Ser. No. 10/703,101,entitled “Method for Assessing Navigational Capacity”, Duffy et al.;U.S. Pat. No. 6,364,845B1, entitled “Methods for Diagnosing VisuospatialDisorientation Or Assessing Visuospatial Orientation Capacity”, Duffy etal.

Further information regarding the field of this disclosed subject matterappears in the following research publications, all of which have commonauthorship by Charles Joseph Duffy and all of which are incorporated byreference in their entirety for all purposes into this detaileddescription: Duffy, Charles J. et al., “Attentional Dynamics and VisualPerception: Mechanisms of Spatial Disorientation In Alzheimer'sDisease”, Brain, 126: 1173-1181 (2003); Duffy, Charles J. et al.,“Visual Mechanisms of Spatial Disorientation in Alzheimer's Disease”,Cerebral Cortex, 11: 1083-1192 (2001).

In the present disclosure, the phrase “optic flow” may be defined as thepatterned visual motion seen by a moving observer that provides cluesabout heading direction and the three dimensional structure of thevisual environment (Duffy et al., “Visual Mechanisms of SpatialDisorientation in Alzheimer's Disease”). Examples of impaired optic flowperception may include, but are not limited to, elementary visual motionprocessing deficits and elevated perceptual thresholds. The benefits ofthe present disclosure can be derived from essentially any analysis ofthe impaired global pattern recognition of optic flow, impaired visualprocessing of optic flow, and perceptual mechanisms of visuospatialdisorientations, such as the ones previously defined.

In the present disclosure, the word “subject” refers to any animal thatmay be able to responds to stimuli. The word “subject” may encompasses ahuman subject, such as a patient. Although the word “subject” is writtenwith the human subject in mind, the word “subject” may be a domesticpet, a work animal, and a robot. More particularly, the word “subject”may include, but is not limited to, a cat, a dog, a rodent, and amonkey. Further, the test referred to in the present disclosure may beimplemented in the same manner for animal subject as for human subjects.

In the present disclosure, the word “functional” may include, but is notlimited to, cognitive, perceptual, neurological, visual, and/orattentional aspects.

In the present disclosure, the word “qualitative”, as referring toqualitative assessment or qualitative monitoring, may refer to apredetermined threshold. A qualitative evaluation may occur when anevaluator, such as the physician or researcher, determines whether thesubject may correctly respond to a series of stimuli that probe theunderlying sensory, cognitive, and neural mechanisms that may beactivated by those stimuli in the setting of a particular responsemodality. Thus a qualitative score may be established based on apredetermined threshold for passing or failing of a health condition.

In the present disclosure, the word “saliency” and the word “salient”both refer to the means by which behavior is modified regardless ofwhether the subject is consciously aware. Further, “saliency” refers tothe ability to detect something regardless of whether the individual isconscious. Further, “saliency” may be defined in absolute terms butscored relative to a normal group, wherein the normal group can befurther defined by single or multiple human characteristics, including,but not limited to, age, gender, medical history, surgical or traumahistory, and genetics. Further, the “saliency” of any of the sensorystimuli may be modulated in at least one of the following ways: 1) The“saliency” may be modulated by filtering the spatial frequencycomposition of the stimuli, thereby making the stimuli harder to see orhear. More particularly, “saliency” may be modulated by filtering thatmay be associated with visually blurring the stimuli. Further,“saliency” may be modulated by filtering that may be associated withauditorily filtering sound by limiting its frequency bands. 2) The“saliency” may be modulated by filtering the temporal frequencycomposition of the stimuli to make the stimuli harder to see or hear.More particularly, “saliency” may be modulated by a filtering processthat may be associated with visually presenting gaps in the otherwisepseudo-continuous stream of video frames, which may typically be sixtyhertz, to a lower value, which may be of forty, thirty, twenty hertz.Additionally, “saliency” may be modulated by a filtering process thatmay be associated with auditorily creating a high frequencyintermittency in the stream of auditory signals.

In the present disclosure, the word “perceptual” may be associated withtemporal constraints on visual attention, such as in by limiting therate at which visual motion signals can be integrated into a coherentrepresentation of self-movement form (Duffy, et al., “AttentionalDynamics and Visual Perception: Mechanisms of Spatial Disorientation InAlzheimer's Disease”). The disclosed subject matter may focus on visualdiscrimination testing and cognitive capacities associated with visualmotion and visual pattern stimuli via control of stimulus selection.However, it is understood that visual discrimination and psychologicalthresholds may be achieved by other neuropsychological tests, so long asthe individual elements assess perceptual impairments or visuospatialdisorientation.

In the present disclosure, the phrase “dual task interference” may beassociated with distinct tasks that may be combined. Further, “dual taskinterference” may refer to two functions of the brain interfering witheach other. The phrase “dual task interference” may further be definedas creating a critical condition of performing more than onesensory-cognitive-motor task at the same time. A “dual task interferencetask” may require a subject to be both aware of the movement of astimulus and also the movement being conducted by the subject. Futureequivalents of the present subject matter may be combined in thismanner.

In the present disclosure, the phrase “pink noise spatial frequency” maybe associated with a signal or process with a frequency spectrum suchthat the power spectral density is inversely proportional to thefrequency. With regards to “pink noise spatial frequency”, each octavecarries an equal amount of noise power.

In the present disclosure, the word “distractor” may be associated with,but is not limited to: a wedge of unique stimulus elements flashing onfor a predetermined time period at a predetermined position, an area ofunique elements flashing on for a predetermined time period at apredetermined position, and the transient displacement of a cursor to apredetermined position. The effects of distractors may include, but isnot limited to, effects of motion, form, and word stimuli. Further a“distractor” may take a subject from a local processing mode, whereinthe subject is processing a particular pattern, to a global processingmode; during this process of transitioning from a local processing modeto a global processing mode, the subject may begun to become distracted.Further, with respect to global motion distractors, if subject switchesdirectly to the global processing mode, then the subject's performancewill indicate improvement in the quantitative assessment of functionalimpairment. Further, with respect to local motion distractors, ifsubject switches directly to the global processing mode, then thesubject's performance will indicate deterioration in the quantitativeassessment of functional impairment, indicated by difficulties infunctional ability. More particularly, a spatial response curve mayindicate the level of difficulty for the subject to switch from a localprocessing mode to a global processing mode in the presence of a“distractor”.

In the present disclosure, the word “cognition” may refer to therelationship between a task and stimulus. Further, the word “cognition”may be associated with the strategic control of how a subject deploysprocessing resources. Further responses and tasks associated withcognition can be performed in more than one way.

In the present disclosure, the word “attention” may refer to the abilityof a subject to perform any of the functional impairment assessmenttests of the present disclosure in the presence of distractor stimuli.Further, “attention” may refer to attaining a performance measurewithout distractors and continuing the functional impairment test whileimplementing the distractors to further evaluate the subjectperformance.

In the present disclosure, the word “luminance” may refer to thebrightness of a stimulus; the total light emitted.

In the present disclosure, the word “contrast” may refer to thedifference between the most and the least luminant elements in a visualdisplay.

In the present disclosure, the word “meta-parameter” may refer tostimulus attributes that may extend across a variety of specificstimulus arrays and response modalities.

In the present disclosure, the word “aspect ratio” may refer to therelative magnitude of orthogonal dimension of a stimulus element.

In the present disclosure, the word “coherence” may refer to theuniformity of a stimulus with respect to some parameter that may beapplied across the extent of the stimulus.

In the present disclosure, the word “eccentricity” may refer to thedistance from the center of a stimulus or the center of a subject'sdirection of gaze.

In the present disclosure, the word “facial expression” may refer to theconfiguration of facial features including the movement and tone offacial muscles.

In the present disclosure, the word “happiness” may refer to theaffective state of positive experience leading to a real or perceivedincrease in the subject's propensity to be attracted to that state.

In the present disclosure, the word “sadness” may refer to the affectivestate of negative experience leading to a real or perceived decrease inthe subject's propensity to be attracted to that state.

In the present disclosure, the word “aggressiveness” may refer to agreater tendency toward, or probability of, an individual's reacting ina violent, intrusive, or threatening manner. Further, “aggressiveness”may be associated with, but is not limited to, any of the following:arms being raised, an erect posture, and an open-mouthed grimace.

In the present disclosure, the word “submissiveness” may refer to alesser tendency toward, or probability of, an individual's reacting in aviolent, intrusive, or threatening manner. Further, “submissiveness” maybe associated with, but is not limited to, any of the following: armsbeing folded, rounded shoulders, and down-cast eyes.

In the present disclosure, the word “body image” may refer to anindividual's internal representation of their own body or the appearanceof their own body to others.

The present disclosure describes a method, system, and tangible computerreadable medium for quantitative assessment of functional impairment ina subject. Complex experimental paradigms in the context ofpsychophysical and electrophysiological studies of spatial or temporalaspects of assessment of functional impairment are greatly improved andsimplified.

Further, the disclosed subject matters also focuses on thequantification of the impact of neural diseases onto affected visualfunctions, but it is understood to be that the concepts presented alsoallow significant improvements with the identification of the earlyphases of neural diseases and neural disorders, as well as withsecondary and tertiary prevention. Moreover the disclosed subject matterprovides an indication for the potential diagnosis of neural diseasesand neural disorders.

Exemplary embodiments of the present invention are directed towardsmethods for organizing and standardizing data from scene testing thatserves as a diagnostic metric for patients with functional impairmentsymptoms, particularly with associated with cognitive, perceptual,neurological, visual, and/or attentional deficiencies, such as thoseassociated with Alzheimer's Disease, Parkinson's Disease, dementia,attention deficit, autism, and schizophrenia. More particularly ondementia, the exemplary embodiments of the present disclosure provide anindication of vascular dementia and frontotemporal dementia.

As will be understood by those of skill in the art, the presentinvention may be practiced in other specific forms without departingfrom the essential characteristics thereof. For example, quantitativeassessment of functional impairment in a subject can have a plurality ofpsychophysical and electrophysiological tests. Or that thepsychophysical and electrophysiological tests may include only a subsetof the test described above, or all of the tests. Furthermore, the orderin which the tests are administered may be varied to suit particularassessment scenarios. Accordingly, the foregoing is intended to beillustrative, but not limiting of the scope of the invention, which isset forth in the following claims.

The foregoing description of the disclosed embodiments is not meant tobe limiting. The above description of the disclosed embodiments is meantto enable any person skilled in the art to make or use the claimedsubject matter. Various modifications to these embodiments will bereadily apparent to those skilled in the art, and the generic principlesdefined herein may be applied to other embodiments without the use ofthe innovative faculty.

In the present specification, an embodiment showing a singular componentshould not be considered limiting. Rather, the subject matterencompasses other embodiments including a plurality of the samecomponent, and vice-versa, unless explicitly stated otherwise herein.Moreover, applicants do not intend for any term in the specification orclaims to be ascribed an uncommon or special meaning unless explicitlyset forth as such. Further, the present subject matter encompassespresent and future known equivalents to the known components referred toherein by way of illustration:

FIG. 1 shows a conceptual framework of the interacting subsystems 110 inthe environment that is used to assess functional impairment in asubject. During the functional assessment process, the step of observermanual response manual 112 is followed by the step of system scoreresponse 114, which is immediately followed by the step of system alertsdisplay target location 116. Upon completing step 116, the step ofsystem alters display difficulty 118 occurs, which is immediatelyfollowed by the decision of composite system output 120. Thereafter, adecision is made to either proceed with the step of record and storestimulus and response parameters 122 or the step of system creates newsensory stimulus array 124. If the decision is to proceed with the stepof system creates new sensory stimulus array 124, then the step ofobserver manual response manual 112 occurs, thereby repeating theensuing steps involved in the conceptual framework of the interactingsubsystems 110.

FIG. 2 displays a workflow of running the method to assess functionalimpairment in a subject. The workflow of functional impairment 126begins with the step of register subject's manipulandum response 128.Immediately thereafter is the step of calculate position error 130,which is followed by the step of calculate velocity error 132. Afterstep 132, the step of determine if errors are increasing or decreasing134 occurs, which is followed by the step of determine target positionand saliency changes 136. Immediately thereafter, the step of change tonew stimulus parameter 138 occurs; thereafter, is the step of step ofregister subject's manipulandum response 128, which results in repeatingthe ensuing steps of the workflow of functional impairment 126.

FIG. 3 depicts a test environment 188 that may be associated withquantitative assessment of functional impairment. The test environment188 may include, but is not limited to those associated with researchand development laboratories, such as those present at medical centers,universities, drug companies, and pharmaceutical companies. Further,quantitative assessment of functional impairment may be conducted inclinics as well as animal research facilities. The present subjectmatter may be implemented in future known equivalents.

Further, quantitative assessment of functional impairment may beconducted remotely from any physical location via the Internet or othernetwork. In addition, the present disclosure may be utilized forperforming therapy, screening tests or more formal evaluations over theInternet.

The present disclosure may provide a test environment 188, which mayinclude a versatile psychophysical testing environment that simplifiescomplex experimental paradigms. The present disclosure may assistclinicians and/or researchers with replicating fundamental studies andbetter investigating visual functions that are impaired by aging andneural dysfunctions, such as shape and motion processing.

Further, the exemplary test environment 188, which is depicted in FIG.3, may include a mounted shroud-box enclosure that may shield thesubject 192 from visual distractors. In systems designed forquantitative assessment of functional impairment, a variety of componentand devices comprise the necessary equipment. The test environment 188in the present disclosure may include, but is not limited to, a subject192, operator 190, subject display 198, stimulus area 199, operatordisplay 194, a subject manipulanduam 402, a shroud 196, a subjectearphones and a subject microphone, an operator earphones and anoperator microphone, and a computing system 200. Further, the subjectheadset 426, which may include a subject earphones and a subjectmicrophone, is shown in greater detail in FIG. 8. Further, the operatorheadset 424, which may include an operator earphones and an operatormicrophone, is shown in greater detail in FIG. 8. More particularly, thecomputing system 200 is shown in greater detail in FIG. 4.

The stimulus area may be presented on the subject display 198 and/or thesubject earphones, wherein the subject earphones may be a component ofsubject headset 426. Further, the cursor 1050 may be located on thesubject display 198. The cursor 1050 may extend from the center of thestimulus area 199 to the edge of a stimulus area 199, such as a circularborder 1302, which is shown in greater detail in FIG. 25.

Further, the cursor 1050 may be the same cursor that is implemented inmultiple tests of the present disclosure, with the exception ofsuperimposed tests. More particularly, functional impairment tests thatinclude superimposed phenomena, may require the alignment of one targetarea with another target area, thereby requiring more than one cursor1050.

Further, the test environment 188 may include a mount device, which maybe a pull-mount or a desk-mount. Further, the subject display 198 mayinclude, but is not limited to, a display screen that is linked thecomputing system by a digital cable. The display screen may be used todisplay instructions, to display an image of the operator 190 duringinstructions or coaching, or to present the visual test stimuli. Thedisplay device 22 may include, or could have as attached, a video cameradirected at the subject 192 to show an image of the subject 192 onoperator display 194. The subject display 198, which is that of thesubject 192, may include a shroud 196 mounted onto a box, in the form ofa shroud-mounted box, in order to shield the subject 192 from the visualdistractors, or may also include earphones in order to present stimuliand shield the subject from audible distractors.

With reference to FIG. 4, an exemplary system within a computingenvironment for implementing the invention includes a general purposecomputing device in the form of a computing system 200, commerciallyavailable from Intel, IBM, AMD, Motorola, Cyrix and others. Componentsof the computing system 202 may include, but are not limited to, aprocessing unit 204, a system memory 206, and a system bus 236 thatcouples various system components including the system memory to theprocessing unit 204. The system bus 236 may be any of several types ofbus structures including a memory bus or memory controller, a peripheralbus, and a local bus using any of a variety of bus architectures.

Computing system 200 typically includes a variety of computer readablemedia. Computer readable media can be any available media that can beaccessed by the computing system 200 and includes both volatile andnonvolatile media, and removable and non-removable media. By way ofexample, and not limitation, computer readable media may comprisecomputer storage media and communication media. Computer storage mediaincludes volatile and nonvolatile, removable and non-removable mediaimplemented in any method or technology for storage of information suchas computer readable instructions, data structures, program modules orother data.

Computer memory includes, but is not limited to, RAM, ROM, EEPROM, flashmemory or other memory technology, CD-ROM, digital versatile disks (DVD)or other optical disk storage, magnetic cassettes, magnetic tape,magnetic disk storage or other magnetic storage devices, or any othermedium which can be used to store the desired information and which canbe accessed by the computing system 200.

The system memory 206 includes computer storage media in the form ofvolatile and/or nonvolatile memory such as read only memory (ROM) 210and random access memory (RAM) 212. A basic input/output system 214(BIOS), containing the basic routines that help to transfer informationbetween elements within computing system 200, such as during start-up,is typically stored in ROM 210. RAM 212 typically contains data and/orprogram modules that are immediately accessible to and/or presentlybeing operated on by processing unit 204. By way of example, and notlimitation, an operating system 216, application programs 220, otherprogram modules 220 and program data 222 are shown.

Computing system 200 may also include other removable/non-removable,volatile/nonvolatile computer storage media. By way of example only, ahard disk drive 224 that reads from or writes to non-removable,nonvolatile magnetic media, a magnetic disk drive 226 that reads from orwrites to a removable, nonvolatile magnetic disk 228, and an opticaldisk drive 230 that reads from or writes to a removable, nonvolatileoptical disk 232 such as a CD ROM or other optical media could beemployed to store the invention of the present embodiment. Otherremovable/non-removable, volatile/nonvolatile computer storage mediathat can be used in the exemplary operating environment include, but arenot limited to, magnetic tape cassettes, flash memory cards, digitalversatile disks, digital video tape, solid state RAM, solid state ROM,and the like. The hard disk drive 224 is typically connected to thesystem bus 236 through a non-removable memory interface such asinterface 234, and magnetic disk drive 226 and optical disk drive 230are typically connected to the system bus 236 by a removable memoryinterface, such as interface 238.

The drives and their associated computer storage media, discussed above,provide storage of computer readable instructions, data structures,program modules and other data for the computing system 200. Forexample, hard disk drive 224 is illustrated as storing operating system268, application programs 270, other program modules 272 and programdata 274. Note that these components can either be the same as ordifferent from operating system 216, application programs 220, otherprogram modules 220, and program data 222. Operating system 268,application programs 270, other program modules 272, and program data274 are given different numbers hereto illustrates that, at a minimum,they are different copies.

A user may enter commands and information into the computing system 200through input devices such as a tablet, or electronic digitizer, 240, amicrophone 242, a keyboard 244, and pointing device 246, commonlyreferred to as a mouse, trackball, or touch pad. These and other inputdevices are often connected to the processing unit 204 through a userinput interface 248 that is coupled to the system bus 208, but may beconnected by other interface and bus structures, such as a parallelport, game port or a universal serial bus (USB).

A monitor 250 or other type of display device is also connected to thesystem bus 208 via an interface, such as a video interface 252. Themonitor 250 may also be integrated with a touch-screen panel or thelike. Note that the monitor 250 and/or touch screen panel can bephysically coupled to a housing in which the computing system 200 isincorporated, such as in a tablet-type personal computer. In addition,computers such as the computing system 200 may also include otherperipheral output devices such as speakers 254 and printer 256, whichmay be connected through an output peripheral interface 258 or the like.

Computing system 200 may operate in a networked environment usinglogical connections to one or more remote computers, such as a remotecomputing system 260. The remote computing system 260 may be a personalcomputer, a server, a router, a network PC, a peer device or othercommon network node, and typically includes many or all of the elementsdescribed above relative to the computing system 200, although only amemory storage device 262 has been illustrated. The logical connectionsdepicted include a local area network (LAN) 264 connecting throughnetwork interface 276 and a wide area network (WAN) 266 connecting viamodem 278, but may also include other networks. Such networkingenvironments are commonplace in offices, enterprise-wide computernetworks, intranets and the Internet.

For example, in the present embodiment, the computer system 200 maycomprise the source machine from which data is beinggenerated/transmitted, and the remote computing system 260 may comprisethe destination machine. Note however that source and destinationmachines need not be connected by a network or any other means, butinstead, data may be transferred via any media capable of being writtenby the source platform and read by the destination platform orplatforms.

The central processor operating pursuant to operating system softwaresuch as IBM OS/2®, Linux®, UNIX®, Microsoft Windows®, Apple Mac OSX® andother commercially available operating systems provides functionalityfor the services provided by the present invention. The operating systemor systems may reside at a central location or distributed locations(i.e., mirrored or standalone).

Software programs or modules instruct the operating systems to performtasks such as, but not limited to, facilitating client requests, systemmaintenance, security, data storage, data backup, data mining,document/report generation and algorithms. The provided functionalitymay be embodied directly in hardware, in a software module executed by aprocessor or in any combination of the two.

Furthermore, software operations may be executed, in part or wholly, byone or more servers or a client's system, via hardware, software moduleor any combination of the two. A software module (program or executable)may reside in RAM memory, flash memory, ROM memory, EPROM memory, EEPROMmemory, registers, hard disk, a removable disk, a CD-ROM, DVD, opticaldisk or any other form of storage medium known in the art. An exemplarystorage medium is coupled to the processor such that the processor canread information from, and write information to, the storage medium. Inthe alternative, the storage medium may be integral to the processor.The processor and the storage medium may also reside in an applicationspecific integrated circuit (ASIC). The bus may be an optical orconventional bus operating pursuant to various protocols that are wellknown in the art.

FIG. 5 shows the paradigm of a hierarchical nature of parametricindividualization. The word “hierarchical” refers to some tests that mayderive measures that may be used as pre-set. Further, the word,“hierarchical” is associated with the occurrence of start values insubsequent tests, such that there may be an ordered sequence of tests.In the hierarchy for parametric individualization 300, the resultingdate from a movement test 302 may be applied to a contrast test 304, anauditory test 306, and/or a vibratory test 308. The results of the oneparticular test or a combination of tests that may include, but are notlimited to, a contrast test 304, an auditory test 306, and/or avibratory test 308, may be applied to the test batteries 310, which arefurther described in the present disclosure.

FIG. 6 portrays a representation of left posterior-lateral view 320 ofthe human brain 322. The human visual system is a system of parallelpathways. In the eyes, there are two sensory system, cone cells fordaylight vision and rod cells for twilight vision. In the optic nervesand visual pathways, there are several different types of nerve fibers,of which the magnocellular pathway 324 and the parvocellular pathway 328are the most important. The magnocellular pathway 324 is considered bythose skilled in the art to be the “where?” pathway; the parvocellularpathway 328 is considered by those skilled in the art to be the “what?”pathway. Further, the magnocellular pathway 324 carries all transient,motion related visual information and low contrast black and whiteinformation. The parvocellular pathway 328 carries all color informationand is effective in carrying high contrast black and white information.Further, the human brain 322 includes a striate and peri-striate visualareas 326, which are well known in the art.

FIG. 7 display an exemplary operator display 194, which an operator 190may utilize to evaluate functional impairment in the human brain 322 ofa subject 192. The operator display 194 may include, but is not limitedto, a real-time subject video display 332, a stimulus display 334, acurrent test performance display 336, and a subject error display 338.Further, the operator display 194 may display the current status 362,which may include, but is not limited to, the current status of thecurrent subject, the current status of the current test, and the currentstatus of the current scores. Further, the test performance display 336may show a graph of stimulus difficulty 350 versus the time of timeintervals 348.

The operator 190 may chose the appropriate test from test batteries 310via the option of select and store test batteries 340. The operatordisplay 194 enables the operator 190 to utilize the features of start342, pause 344, and stop 346 with respect to any functional assessmenttest. Further, an operator 190 may chose a test from among the testbatteries 310. For instance, the operator 190 may chose a functionalassessment test that may be symbolized as test battery A 352, testbattery B 354, test battery C 356, test battery D 358, or test battery X360, as in shown on the exemplary operator display 194 of FIG. 7.

Further, the operator display 194 may be used to start and stop testingvia a series of windows that may be shown by the use of the computingsystem 200. The series of windows may include the following:

i) A window for data entry regarding the subject 192, operator 190, andtest site.

ii) A window for the operator 190 being able to view the subject'sstimulus for monitoring.

iii) A window for the display of the current subject 192 and ongoingtest.

iv) A window for the real-time display of graphical subject error andnumerical subject error.

v) A window for the display of the subject's video image to the operator190 for the monitoring of the subject's position and gaze.

vi) A window for the display of the subject's response saliencyfunction.

vii) A window for the display of the subject's current basic scores.

viii) A window for the operator 190 to enter comments.

ix) A window for the operator 190 to enter identifying, medical history,treatment, etc.

The operator display 194 may be one component, of many components, thatmay be utilized for quantitative assessment of functional impairment.FIG. 8 illustrates an embodiment of the principal components of thepresently disclosed method for assessment of functional impairment. Theprincipal components may include, but are not limited to, basiccomponents 400, a subject manipulandum 402, an operator interface 404,and closed-circuit communication 406. The basic components 400 may beutilized in the test environment 188, as is shown in FIG. 3.

The operator interface 404, may include, but is not limited to devicesspecifically for use by the operator 190, such as a keyboard 244, hereincalled operator keyboard 408, and a pointing device 246, which may be,but is not limited to, an operator touchpad 410 or a mouse, hereincalled an operator mouse 412. A operator 190 may enter commands andinformation into the computing system 200 through input devices such asan operator touchpad 410 or an operator mouse 412. The operator 190 mayutilize the operator interface 404 for entering identifying information,medical history, treatment data, etc. to facilitate in quantitativeassessment of functional impairment.

Further, the closed-circuit communication 406 may include, but is notlimited to, an operator headset 424, which may be utilized by theoperator 190, and a subject headset 426, which may be utilized by thesubject 192. The present disclosure may include a closed-circuitauditory link 406 between the subject 192 and the operator 190 thatconsists of three components:

i) The subject 192 may utilize a subject headset 426 to shield fromaudible distractors, thereby allowing for the controlled presentation ofauditory stimuli as task cues or distractors, or cue elements of thetask, which include, but are not limited to, specific tones and words,or for instructions or for coaching by the operator 190. The subjectheadset 426 may include a co-mounted subject microphone 428, which mayalways be on to the operator 190, thereby allowing all comments by thesubject 192 and eliciting appropriate responses.

ii) The operator 190 may wear an operator headset 424 that may allow theoperator 190 to hear any sounds from the subject 192 but also may allowthe operator 190 to hear sounds from the surrounding environment. Theoperator headset 424 may include a co-mounted operator microphone 425,which may allow the operator 190 to speak with the subject 192. Further,the operator interface 404 may allow for contact with the subject 192via the operator 190 being able to enable or disable a virtual switch inthe operator display 194.

iii) The present disclosure includes software, hardware, and interfaceconnections for controlling the state of the subject-operatorclosed-circuit communication 406.

Further principal components of the presently disclosed method forassessment of functional impairment may include a subject manipulandum402, which may be a physical interfacing device that transforms inputfrom a user. The properties of the subject manipulandum 402 may be akinto the properties of a pointing device 246 or other input devices, whichmay include, but is not limited to a wheel, a joystick, or a computermouse device. Further, the subject manipulandum 402 may be a touchscreen display panel 422 that can accommodate finger or stylus input,such as by text.

Similar to the operator interface 404, the subject manipulandum 402 mayinclude, but is not limited to devices, such as a keyboard 244, hereincalled subject keyboard 409, and a pointing device 246, which may be,but is not limited to, a subject touchpad 411 or a mouse, herein calledan subject mouse 420. A subject 192 may enter commands and informationinto the computing system 200 through input devices such as an operatortouchpad 411 or an operator mouse 420.

Further, the subject 192 may respond exclusively by moving thepositional control of the subject manipulandum 402, which is chosen tomeet the design of the test. The subject manipulandum 402 may bemanipulated by the hand of the subject 192, and its purpose is tomaximize stimulus response compatibility so that sensory processingmotor control aspects are not obscured. The subject 192 may provideinput and respond to sensory stimuli by movement of the subjectmanipulandum 402 via one of the following options: a rotary manipulandum414, a linear manipulandum 416, or a xy Cartesian manipulandum 418.Thus, the subject manipulandum 402 may move in rotation motion 440, alinear motion 442, x-axis motion in the Cartesian coordinate system 444,or y-axis motion in the Cartesian coordinate system 446. In addition,the movement of the subject manipulandum 402 may be represented as acursor 1050 on the subject display 198. The cursor may be, but is notlimited to, a ball-and-stick cursor.

With reference to FIGS. 9, 10, and 11, an exemplary a rotarymanipulandum 414, an exemplary linear manipulandum 416, and an exemplaryxy Cartesian manipulandum 418 are shown in greater detail.

Further, the subject manipulandum 402 may be designed to incorporate ameans of monitoring whether the subject 192 is contacting a handlethrough a capacitive contact detector. Further, the subject manipulandum402 may be designed to incorporate a motorized system that can alter theresistance offered by the subject manipulandum 402 to the subject 192 bymoving it for use in testing the motoric control of the subject 192.Further, the subject manipulandum 402 may be designed to incorporate avibrating element that can create a variable amplitude, variablefrequency vibration of a handle as a cue or a distracting stimulus.

Further, the present disclosure may accommodate the use of a pluralityof subject manipulandum 402 to test the motoric control of the subject192. The present disclosure may accommodate two manipulandum 402, onewith each of the subject's hands.

Further, the response of the subject manipulandum 402 may be implementedas separate box mounted devices or virtual devices on a touch screendisplay panel 422 that can accommodate finger or stylus input, such asby text.

Further the present disclosure may include a principal component of acomputing system 200, which may include a computer readable medium ormay include a computing process, that supports detailed operations byinterfacing with other hardware components and by representativesoftware described in the further in the present disclosure.

More particularly, the subject manipulandum 402 may be a rotarymanipulandum 414 that moves in a rotational motion 440, as is shown inFIG. 9. The rotary manipulandum 414 may consists of a box mounted wheel439, which may be mounted such that it can rotate around its center,which may be attached to a rotation circuit in the box 443. The boxmounted wheel 439 is moved by grasping an eccentric handle 441 that thesubject 192 uses to rotate the angle of the rotary manipulandum 414,which may be a displayed as a cursor 1050 on the subject display 198.The motion of the rotary manipulandum 414 may be from zero tothree-hundred sixty angular degrees, which may be translated with asrepresentative motion, also from zero to three-hundred sixty angulardegrees, in the form of a cursor 1050 on the subject display 198.

FIG. 10 presents a linear manipulandum 416 that moves in a linear motion442. The linear manipulandum 416 may consist of a box-mounted slot 445from which a handle 447 protrudes. The handle 447 is attached to circuitin the box 443 that transduces the movement of the handle 447 across theextent of the slot 445. The handle 447 is grasped by the subject 192 andmoved along the axis of the slot 445, which may move the cursor 1050 onthe subject display 198. The movement of the cursor 1050 may berepresented as a displayed linear cursor on the subject display 198. Thedisplayed linear form of the cursor 1050 may move in a variety of means,including, but not limited to, a side-to-side motion or an up- and downmotion, across a corresponding axis of the stimulus area 199.

FIG. 11 shows a xy Catersian manipulandum 418 that moves in theCartesian coordinate system, which may be x-axis motion in the Cartesiancoordinate system 444 or y-axis motion in the Cartesian coordinatesystem 446. The xy Catersian manipulandum 418 may consist of a boxmounted handle 449 that is attached to a xy Cartesian coordinatetransducer circuit that registers the position of the handle's angulardeflection. The box mounted handle 449 is tilted by the subject 192 todisplace a cursor 1050 across the xy surface of the subject display 198;the xy surface of the subject display 198 may be shown from the upperleft to the lower right of the subject display 198.

FIG. 12 portrays a block diagram of a stimulus generator 450, which mayfurther comprise the system software 452, the application hardwareconfiguration 454, and the system conceptualization of neural processing456. Further, the block diagram of a stimulus generator 450 may combinehardware and software to produce a scene parameter.

The system software 452 may consider the test subject error monitor 460towards both the steps of derive new target location 462 and derive newstimulus difficulty 464. The results of the steps of derive new targetlocation 462 and derive new stimulus difficulty 464 may influence thestep of system test-module-specific stimulus generation 468.

Further, the steps involved in the system software 452 may influence thesteps involved in the application hardware configuration 454. Moreparticularly, the results of the step of system test-module-specificstimulus generation 468 may be applicable towards each of the steps thatare associated with the computer's sound's engine (firmware) 474, thecomputer's graphics engine (firmware) 472, and the computer's signalgenerator (firmware) 470.

The results of the step associated with the computer's sound's engine(firmware) 474 may be applicable towards the step associated withcomputer's sound interface (hardware) 476. The results of the stepassociated with the computer's graphics engine (firmware) 472 may beapplicable towards the step associated with computer's graphicsinterface (hardware) 480. The results of the step associated with thecomputer's signal generator (firmware) 470 may be applicable towards thestep associated with the computer's digital interface (hardware) 484.

Further, the results of the step associated with the computer's soundinterface (hardware) 476 may be applicable towards the step associatedwith the subject's auditory headset (hardware) 478. The results of thestep associated with the computer's graphics interface (hardware) 480may be applicable towards the step associated with the subject's visualdisplay (hardware) 482. The results of the step associated with thecomputer's digital interface (hardware) 484 may be applicable towardsthe step associated with the subject's vibro-tactile manipulandum(hardware) 486.

Further, the steps involved in the application hardware configuration454 may influence the steps involved in the step of systemtest-module-specific stimulus generation 468. More particularly, thesteps associated with either of the subject's auditory headset(hardware) 478, the subject's visual display (hardware) 482, or thesubject's vibro-tactile manipulandum (hardware) 486 may be associatedwith the step of system test-module-specific stimulus generation 468.

FIG. 13 shows a block diagram of the subject manipulandums 550, whichrepresents the necessary components associated with the subjectmanipulandums 402. The components a of the block diagram of the subjectmanipulandums 550 may include, but is not limited to, the manipulandumhandle and transducer 552, a USB interface 554, signal conditioning 556,and the USB connector to system computer 558. Further, the manipulandumhandle and transducer 552 may be associated with either of the rotarymanipulandum 414, linear manipulandum 416, or xy Cartesian manipulandum418.

The output associated with the manipulandum handle and transducer 552 iscoupled to the signal conditioning 556, which may either be applicabletowards the USB interface or directly with the USB connector to systemcomputer 558. The output associated with the USB interface is directlycoupled to the USB connector to system computer 558.

FIG. 14 portrays an exemplary operator output interface 570, which mayinclude, but is not limited to, an operator display 194 and an operatorinterface 404. The operator display 194 is shown in greater detail inFIG. 7 and its accompanying description. The operator interface 404 isshown in greater detail in FIG. 8 and its accompanying description.Further, the operator display 194 may include an exemplary real-timesubject video display 332 for presenting tests of a series of scenes foruse with the presently disclosed subject matter.

FIG. 15 depicts a sub-component of the operator display 194, the poweruser preset controls for visual movement module 600, which may serve asa graphical user interface with parameter adjustment sliders andbuttons. The operator 190 may control the power user preset controls forvisual movement module 600 in order to make changes to one, several, orall of the settings associated with the movement test 302. The poweruser preset controls for visual movement module 600 may include, but isnot limited to, slider bars, with accompanying value ranges for thestimulus area 602, the stimulus speed 604, the range of dot speeds 606,the dot color 608, the background color 610, the mean dot luminance 612,the dot size (min, max) 614, the dot half-life (msec) 616, and the dotoverlap (max %) 618.

FIG. 16 presents a window in the operator display 194, which in additionto the option of select and score test batteries 340, may also includean exemplary subject demographics entry display 650. The operator 190may enter subject demographics 652 for the subject 192 in the subjectdemographics entry display 650, which may be a sub-component of theoperator display 194. The subject demographics may include, but are notlimited to, the full name 660, the stated age 662, the date of birth664, the gender identity 666, the racial identity 668, and the ethnicidentity 670.

FIG. 17 shows a window in the operator display 194, which in addition tothe option of select and score test batteries 340, may also include anexemplary subject medical history entry display 700. The operator 190may enter the medical history 710 and the functional capacities 712 forthe subject 192 in the subject medical history entry display 700, whichmay be a sub-component of the operator display 194. Further the medicalhistory 710 may include, but is not limited to, medicinal allergies 720,other allergies (seasonal/food) 722, current medications 724, currentsupplements 726, current diagnoses 728, surgical procedures 730, plannedsurgeries 732, and history of trauma 734. Further the functionalcapacities 712 may include, but is not limited to, physical limitations736, hearing impairments 738, visual impairments 740, movementdifficulties 742, highest educational level 744, and preferred hand 746.The medical history 710 and the functional capacities 712 may contributetowards the quantitative assessment of functional impairment, andthereby may contribute towards the treatment for the subject 192.

FIG. 18 shows a standard operations test scoring display 750, which maybe a window in the graphical user interface for the display of thesubject's current basic scores. The standard operations test scoringdisplay 750 may be a display in addition to the option of select andscore test batteries 340, which may be a part of the operator display194.

The standard operations test scoring display 750 may further display amore detailed test scoring display 752, which may include, but is notlimited to, the test subject output 760, the test module output 762, thesaliency scores output 764, the mean over previous output 766, theinterval scores output 768, and the percentage time at five secondslevel output 770. Further, the test scoring display 752 may show currentdata associated with a current, particular test that may be forquantitative assessment of functional impairment.

Further, the mean over previous output 766 may be associated with thesaliency scores output 764. Further, the percentage time at five secondslevel output 770 may be associated with the interval scores output 768.

FIG. 19 shows a window in the operator display 194, which in addition tothe option of select and score test batteries 340, may also include anexemplary standard operations dynamic performance display 800. Thecurrent test performance 802, which may be represented graphically asthe graph of current of current test performance 804, which may be agraph of stimulus difficulty 350 versus ten seconds intervals 806.

Further, the ten seconds intervals 806 is an exemplary representation ofthe time from the start of this test 808. However, different timeintervals may be represented on as the time from the start of this test808 on the graph of current of current test performance 804.

Further, the graph of current of current test performance 804 mayrepresent increasing task difficulty 812 with a higher value of stimulusdifficulty 350. Further, the graph of current of current testperformance 804 may represent decreasing task difficulty 810 with alower value of stimulus difficulty 350.

Further, the current test performance 802 may be a more detailedrepresentation of the standard operations dynamic performance display800. Further, the current test performance 802 may be associated withthe subject's response saliency function.

FIG. 20 shows a window in the operator display 194, which in addition tothe option of select and score test batteries 340, may also include anexemplary operator comments entry display 850. The operator 190 mayenter comments on the operator comments entry 852, which may be asub-component of the operator comments entry display 850. The operatorcomments entry 852 may include, but is not limited to, prompts forsubject response to test experience 854, operator assessment of subjectperformance 856, subject comments 858, and operator comments 860.

Further, the subject response to test experience 854 may be scored on ascale of subject response to test performance 862, which may be scored,but is not limited to being scored, from very unenjoyable 870 tomoderately unenjoyabled 872 to moderate 874 to moderately unenjoyable876 to very enjoyable 878. The operator assessment of subjectperformance 856 may be scored on a scale of operator assessment ofsubject performance 864, which may be scored, but is not limited tobeing scored, from very unenjoyable 870 to moderately unenjoyable 872 tomoderate 874 to moderately unenjoyable 876 to very enjoyable 878.

With reference to FIG. 21 through FIG. 78, the present disclosureincludes multiple levels of system configurability implemented with anextensive multi-dimensional parametric control system with a largenumber of parametric adjustment controls. These parameters allow for theflexible specialization of the present disclosure across manyapplication domains as well as the flexible specialization of thepresent disclosure to specific medical diagnoses and correspondingissues related to the wide variety of directly foreseeable applicationsof this technology.

The present disclosure allows for specialization of parameters withregards to tests included for specific applications, which may included,but is not limited to the following:

i) The present disclosure allows for the selection of specific tests forspecific applications, such as a test array emphasizes posteriorcortical and sub-cortical function in applications regarding Alzheimer'sDisease, and in contrast, a different test array in screening of frontallobe and temporal lobe function in applications regarding thefronto-temporal dementias.

ii) The present disclosure may allow assessment of the underlyingmechanisms for drug and toxin exposures. Specific applications for drugand toxin exposures may be selected by experience acquired fromimplementation of the present disclosure.

iii) The intrinsic configurability that is fundamental to the presentdisclosure also allows for implementing a broad-based, non-specializedscreening array when such an array best serves specific applications.

iv) The present disclosure may include a power-user test arrayconfiguration mode in which a specific sub-set of tests from the presentdisclosure may be included or excluded as best suited to the specificinterests of the customer or for specific applications.

v) As a result of the intrinsic configurability, the total duration oftesting as described in the present disclosure may vary widely acrossapplications.

Further, the present disclosure may provide for a complete, streamlineworkflow of experimental design, display calibration, data collection,and data analysis for the quantitative assessment of functionalimpairment. The experiment is the root event that specifies theparameters that may be implemented during the experiment.

Specialization of parameters for test configuration to be used inspecific applications may include, but is not limited to, the following:

i) The present disclosure may allow for the selection of all physicalparameters of all the tests described in the present disclosure. Suchparametric configuration includes altering the speed of target motion,the rate of target saliency increase or decrease, spatial and temporalfrequency composition of the stimuli and the nature of multi-modalstimuli, such as visual stimuli alone, auditory stimuli alone,hand-finger vibratory tactile stimuli alone, or any combination of thosemodalities as cues or distractors.

ii) The present disclosure's parametric adjustment setting may includeall aspects of the visual display, including, but not limited to,luminance, contrast, spatial and temporal frequency composition, targetmovement, all aspects of the test subject's motor control medium,including but not limited to, adjusting response sensitivity, filteringsubject response signal frequency, and all aspects of auditory input tothe subject, including, but not limited to, visual and/or auditorypresentation of instructions, visual and/or auditory presentation oftest stimuli, such as words or tones, the presentation of auditorystimuli as distractors, and the amplitude and filtering of auditorystimuli.

iii) The present disclosure may include parametric adjustment due toqualitative assessment. Such parametric adjustment, such as the abilityto select parameters that are derived from demographic specification ofthe individual, which may include, but is not limited to, age, gender,medical history, drug treatments, or from the results of specific testsin a testing array sequence, which may include, but is not limited to,using a contrast sensitivity profile to alter the contrast at which allother visual stimuli will be presented, or using the speed and othersubject movement parameters to alter the target movement parameters forall other tests. These subject performance dependent meta-parameters maybe used as directly derived from that subject's or subject group'sperformance or may be algorithmically programmed.

iv) The present disclosure may include a power-user test parametricconfiguration mode in which computerized parameter adjustment slidersand buttons may be presented to allow for the adjustment of parametersas best suited to the specific interests of the customer or for specificapplications.

Further, specialization of the testing configuration for applications totesting specific subjects may allow for the selection of a language inwhich instructions and linguistic cues that may be presented for testingsubjects native to other languages.

Further, specialization of the testing configuration for applications totesting specific subject may allow for the selection of relevant cuessuch as geometric shapes or tones or such as objects and recognizablesounds rather than language cues in applications for age-appropriate,developmental, or acquired impairments of language processing.

Further, specialization of testing configuration for applications totesting specific subject may allow for using an individual subject'sscores from a previous testing session, at that site or another testsite. Further, specialization of testing configuration for applicationsto testing specific subject may allow for using an individual subject'sscores to select the test to be administered, which may potentiallyfocus on abnormal or unreliable performance or on application specificselected performance Likewise, test configuration parameters may beinherited from previous testing sessions to match those tests or toextend testing in to a different parametric domain.

Further, specialization of the testing configuration for applications totesting specific subject may allow for operator entered alerts on areasof concern, which may be in response to subject complaints alerting thephysician or operator regarding some function, such as memory.

The present disclosure may include the extensive processing of subjectperformance data integrated with information from sources that mayinclude: i) subject demographics, such as from scores standardized tonormal for age or education, ii) subject characteristics from anestablished diagnosis or know treatment that may alter or focusanalysis, such as with motor response in Parkinsonism, or iii) previoustest scores, such as to focus on measuring improvement, stability ordecline.

The present disclosure may include on-line data analysis, which mayinclude the presentation and archiving of summary scores at thetermination of the administration of each test. The scores from thesetests may include: the mean saliency, as percent of maximum score, inlast fifteen, ten, and five seconds of a test, the saliency at which thegreatest percentage of time was spent in a test, the saliency at whichthe subject first lost track of the target. In another embodiment, thepresent disclosure may generate real-time score during theadministration of each test.

The present disclosure may include off-line data analysis, which mayinclude the derivation of a variety of dependent measures, including,but not limited to: i) the subject's response curve fit parameters to anasymptotic function, the salience level of that asymptote, and the timeit takes to achieve that asymptote, ii) the area under the curve of thesubject's response function, terminated by either a preset time, such asone-hundred seconds of testing or thirty seconds after the asymptote isreached, or the time to three peak/troughs in the response function orthe time until a pre-selected cut-off is achieved, such as a saliencygreater than ninety-five percentage, iii) comparative evaluations suchas the differences between the measures of a subject's performance on aselected test versus that from another selected test, iv) comparativemeasures such as the differences between the basic measures of a subjecton a test and the measures from a selected group of comparison subjects,such as the percentile scaled performance scores standardized for age,gender, and education.

More particularly, system initiation and test initiation, as applied tothe quantitative assessment of functional impairment as described in thepresent disclosure, may be shown by way of illustration. FIG. 21 showsan embodiment of a testing flow process 1100 for the conceptualframework for quantitative assessment. At the start step of testing flowprocess 1100, the system initiation sequence 1102 may begin with theboot and self-test step 1106 and may proceed to initiate operatorinterface at step 1108. Upon receiving data entry input from theoperator 190 via the operator interface 1120 during the initiateoperator interface step 1108, the system initiation sequence 1102 may becompleted.

The ensuing test initiation sequence 1104 may commence subsequently withthe session script step 1122. Upon receiving operator confirmation 1124the session demo 1126 begins with the session demo stimulus 1128. Atstep 1130 of patient responses, score results 1132 are recorded.Thereafter, done query 1134 may ascertain whether the session demostimulus 128 has finished. If done query 1134 is no, then the testinitiation sequence 1104 reverts back to the session demo stimulus 1128.If done query 1134 is yes, then the test initiation sequence 1104proceeds with store results step 1136.

Thereafter, testable query 1138 may discern whether the store resultsare testable. If testable query 1138 is no, then the test initiationsequence 1104 determines a resulting untestable script 1140, and therebyproceeds step of to test closing step 1144. If testable query 1138 isyes, then the test initiation sequence 1104 proceeds with the to testcontrol 1142, which is further depicted in FIG. 22 with more detailedsteps.

More particularly, test control and test presentation, as applied to thequantitative assessment of functional impairment as described in thepresent disclosure, may be shown by way of illustration. FIG. 22displays a sequence of test control steps 1152 and a sequence of testpresentation steps 1154. At the test control step 1142 indicated in FIG.21, the test initiation sequence 1104 may progress into the sequence oftest control steps 1152. Initially after the from test initiation orpresentation step 1156, the sequence of test control steps 1152 proceedsto the query test selection 1160. Query test selection 1160 may searchto allocate an appropriate test to/from test sequencing 1158. Uponachieving test selection 1160, the sequence of test control steps 1152may proceed to test closing step 1142 under the assumption of noremaining tests. Further, upon achieving test selection 1160, thesequence of test control steps 1152 may proceed to the test script step1164 under the assumption of remaining tests.

The operator enable step 1166 may promote the introduction of the testdemo stimulus 1168. The sequence of test control steps 1152 may proceedwith receiving input via patient responses 1170, for which the testingflow process 1100 records the score results 1132. If the sequence oftest control steps 1152 does not complete score results 1132, then thesequence of test control steps 1152 continues with test demo stimulus1168 in a control loop until the sequence of test control steps 1152completes score results 1132.

Upon achieving score results 1132, the sequence of test control steps1152 may proceed to the store results step 1136 and then to the testablequery 1138. If testable query 1138 is yes, then the sequence of testcontrol steps 1152 may proceed to step of to test presentation 1180 andinitiates the sequence of test presentation steps 1154, starting withthe step of from test control 1182. Then, at from test control step1182, the sequence of test presentation steps 1154 may proceed withhaving a particular test x ready step 1184, followed by the step ofoperator confirmation 1124.

However, if testable query 1138 is no, then the sequence of test controlsteps 1152 may proceed to the step of to test control 1142. Afterward,the sequence of test control steps 1152 may revert back to the testinitiation or presentation step 1156.

Upon receiving operator confirmation 1124, the sequence of testpresentation steps 1154 may present a particular test x present stimulusstep 1188, thereby promoting patient responses 1170. Subsequently, thepatient responses 1170 may be recorded in the score and store step 1192,thereby prompting the test time-out query 1194. If test time-out query1194 is no, then the sequence of test presentation steps 1154 proceedsto the query of stable score 1196.

However, if test time-out query 1194 is yes, then the sequence of testpresentation steps 1154 may proceed to the step of to test control 1142,thereby reverting to the test initiation or presentation step 1156. Iftest time-out query 1194 is no, then the sequence of test presentationsteps 1154 may present the stable score query 1196. If stable scorequery 1196 is no, then the sequence of test presentation steps 1154 mayrevert back to the step of operator confirmation 1124. However, ifstable score query 1196 is yes, then the sequence of test presentationsteps 1154 to the step of to test control 1142, may revert back to thetest initiation or presentation step 1156.

More particularly, test sequencing and test closing, as applied to thequantitative assessment of functional impairment as described in thepresent disclosure, may be shown by way of illustration. FIG. 23illustrates the process flow of test sequencing 1202 in greater detailthan as discerned at the step of from test control 1182 of FIG. 22. Thesubset of steps of from test control 1182 may begin with the from testcontrol ‘select’ step 1206 of test sequencing 1202. Thereafter, a newpatient query 1208 inquires whether a new patient has elected toparticipate in the test sequencing 1202. If no to new patient query1208, then a first test query 1210 may be administered. If yes to newpatient query prompt 1208, then the test sequencing 1202 proceeds to thestep of access test battery 1216. Upon initiating first test query 1210,the test sequencing 1202 commences the step of load patient parameters1212. Thereafter, the step of reviewing patient's parameters 1214commences.

Further, the patient parameters reviewed 1215, which may be consideredin the step of reviewing patient's parameters 1214, may include, but isnot limited to the following: confirm patient identity, specialwarnings, previous scores for report, test priorities (future), andconflict in new and old data.

Immediately following step of reviewing patient's parameters 1214, thestep of access test battery 1216 may commence. Thereafter, theprogression of tests may be initiated in the step of next test insequence 1218, which may include a particular test type 1219. Further,the particular test type 1219 may further include, but is not limitedto, tests associated with any, some, or all of motor, form, motion,attention, word, and memory characteristics.

Further, the step of next test in sequence 1218 may start a sequence ofthe step of load test and its pre-sets 1220, which is immediatelyfollowed by an analysis step of this test's parameters battery 1222.More particularly, the step of this test's parameters battery 1222 mayinclude, but is not limited to the details of type of parameter battery1223, which is listed in list form detail in FIG. 23.

The final step of test sequencing 1202 may be the step of to testcontrol ‘selection’ 1224, which returns the testing flow process 1100back to the sequence of test control steps 1152, starting with the testinitiation or presentation step 1156. Upon completion of tests andsaving test data at the store results step 1136, the sequence of stepsin test closing 1204 begins with the step of from test initiation orcontrol 1226.

Thereafter, the step of request operator comments 1228 seeks operatorcomments 1230, which may be stored as store comments 1232 via a dataarchiving mechanism 1234. Subsequently, the user is prompted by thequery of print results 1236 and the query of printer available 1238. Ifno to the query of printer available 1238, then the step of flag printreminder 1240. If yes to the query of printer available 1238, then thestep of printer que 1242, immediately followed by the prompt of anotherpatient 1244 to print another patient's test results.

Thereafter, a query of new patient requested 1246 may be initiated. Ifno to query of new patient requested 1246, then the step of auto logoutand to system initiation login 1248 appears to the user. If yes to queryof new patient requested 1246, then the step of to system initiationpatient ID 1249 appears to the user.

More particularly, data archiving, operator interface, and accountsmanagement, as applied to the quantitative assessment of functionalimpairment as described in the present disclosure, may be shown by wayof illustration. FIG. 24 shows sub-sequences of the testing flow process1100, which may include the sequences of steps for data archiving 1250,operator interface 1252, and accounts management 1254. The process flowof data archiving 1250 may commence from the end of the sequence ofsteps in test closing 1204 as shown in FIG. 23.

Thereafter the steps for data archiving 1250 may commence with the stepof access all previous results 1256, which are formatted in the step offormat raw data and reported data 1258. Upon formatting the data fromthe test sequencing 1202, the data may be stored in the step of storeraw data and reported data 1260. Thereafter, the process flow of dataarchiving 1250 may proceed with the step of flag type of billing 1262and the subsequent step of encrypt and lock file 1264. The process flowof data archiving 1150 may end with return to test closing 1266.

FIG. 24 also shows sub-sequences of the testing flow process 1100 forthe operator interface 1252, which may begin with the step of fromsystem initiation sequence 1282. Thereafter, the operator interface 1252may proceed with the step of create multi-function display 1268, whichis immediately followed by the step of start AV link to patient 1270.Next the operator interface 1252 may proceed the step of startstimulus/response display and score 1272, which initiates the subsequentstep of start patient error display and store 1274 and the ensuing stepof display the test battery and ready status 1276. Thereafter, the usermay be prompted the step of ready to go 1278, which may be immediatelyfollowed by the step of to system initiation session initiation 1280.

Moreover, FIG. 24 also shows sub-sequences of the testing flow process1100 for accounts management 1254, which may begin with the step of fromsystem initiation 1282. Thereafter, the user may be queried with thestep of accounts management system 1284. If no to the query of accountsmanagement system 1284, then the follow-up step may be the query localadmin 1294 to determine whether the user a local administrator. If yesto the query of asking whether the user is a local admin 1294, thenaccounts management 1254 may proceed to the step of local tests andbilling 1295. However, if no to the query of asking whether the user isa local admin 1294, then accounts management 1254 may proceed to thestep of the asking whether the user is a local operator 1190 via thequery of local operator 1296. If yes to the query of local operator1296, then accounts management may proceed to the step of to systeminitiation accounts management 1298; otherwise, accounts management mayproceed to the step of to system initiation login prompt 1299.

Instead, if yes to the query of accounts management system 1284, thenthe testing flow process 1100 for accounts management 1254 may proceedwith the step of pre-confirm and permissions 1286, which may beimmediately followed by the step of confirming via the query confirmed1288. If no to the query confirmed 1288, then the testing flow process100 for accounts management 1254 may proceed to the step of poll systemserver now 1292. Instead, if yes to the query step of inquiringconfirmed 1288, then the testing flow process 1100 for accountsmanagement 1254 may proceed to the step of system access 1290.Thereafter step of system access 1290, accounts management 1254undergoes user exit mode and ends the accounts management 1254 at the tosystem initiation login prompt 1199.

With reference to FIG. 25 through FIG. 78, the present disclosureincludes a screening test battery with high stimulus-responsecomputability to facilitate engaging test subjects while surveying arange of functional domains to detect and quantify a variety offunctional impairments.

The fundamental stimulus response contingency common to all of thesetests is the segmental presentation of a stimulus in the context ofrelevant distractors to evoke the subject's positioning of a cursor toindicate the local stimulus.

In one embodiment of the present disclosure, the tests are organized tocaptures all aspects of sensory input, cognitive transformation, andmotoric response, herein called sensory-motor neurocognitive assessment,which may also be known as sensory-cognitive motor tasks. The presentdisclosure may couple sensory stimulation with the recording of motorresponses to assess cerebral cortical function. The stimulus-responsepatterns are recorded in the context of the different tests, whichthereby allow for: 1) the quantification of fundamental sensory andmotor functions, 2) the quantification of multiple levels of highcognitive function by measuring its influence on motor function, and 3)the detection of impairments or improvements in any of these functions.

The tests may provide a graph of saliency over time in tasks ofsensory-motor neurocognitive assessment task. Further, the tests of thepresent disclosure may characterize functional impairment insensory-motor neurocognitive assessment through evaluation ofquantifiable characteristics.

One such quantifiable characteristic of impairment in sensory-motorneurocognitive assessment may be high latency to the subject's optimalfunction in a sensory-motor neurocognitive assessment task, which may bea less steep sensory-motor neurocognitive assessment function.

Another such quantifiable characteristic of impairment may be highvariability of optimal function during a sensory-motor neurocognitiveassessment task, which may be larger terminal fluctuations.

Yet another such quantifiable characteristic of impairment may be lowenhancement of sensory-motor neurocognitive assessment function,particularly being steeper or higher, by valid cueing. The term “validcueing” may refer to providing a stimulus that allows the subject tohave fore-knowledge of a subsequent stimulus, accessing attention ormemory that may be able to provide correct information.

Another such quantifiable characteristic of impairment may be highdiminution of sensory-motor neurocognitive assessment function,particularly being flatter or lower, via invalid cueing. The term“invalid cueing” may be when attention or memory provides incorrectinformation about the nature or content of the sensory-motorneurocognitive assessment task.

Further, a disclosed embodiment of the present disclosure may include amotion associated with a stimulus area 199 that may be translationmotion, radial motion, or motion that may be in a combination oftranslation motion and radial motion. Further, the motion associatedwith the stimulus area 199 may be random in nature.

Further, another embodiment of the present disclosure may includecontinuous feedback adjusted stimulation. More particularly, the stimulimay have target location specificity, wherein a spatial sub-section ofthe stimulus is distinct from the remainder of the stimulus by virtue ofa gradient or boundary of difference in a single stimulus parameter or aselected set of stimulus parameters. Such a boundary may reflect asingle step change at some edge, multiple step changes at successivedistances steps away from the target's center, or a graded function withdistance from the center of the target.

Further, the tests of the present disclosure may continually change thelocation of the target in the stimulus field. The present disclosure mayinclude a continually changing response from the subject 192. The targetlocation may change by either angular displacement around an axis ofrotation, displacement along a single axis or any fixed or varyingorientation, or displacement along multiple axes, such as horizontal andvertical axes.

Additionally, the saliency of the target, which refers to perceptualdistinctness of the target from the background, may be continuallychange during a sensory-motor neurocognitive assessment to alter thedifficulty of the task and establish the sensory-motor neurocognitiveassessment response function of the subject 192 in the sensory-motorneurocognitive assessment domain.

Further, in the tests of the present disclosure, the cursor 1050 mayitself be the target zone of one of the superimposed overlapping testsin which the target position in another test may be controlled as a testtarget stimulus when the cursor 1050 is presented itself. A computersystem 200 may control the saliency associated with the cursor 1050,thereby allowing the subject 192 to perform two sensory-cognitive-motortasks concurrently, a circumstance which may be associated with dualtask interference. More particularly, the subject 192 may be asked toalign one target area with another target area during functionalimpairment testing associated with dual task interference.

Further, during the tests of the present disclosure, the subjectperformance controls the rate and direction of change in target locationand saliency. The speed, maximum acceleration, and rate of directionchanges may be increased when the subject 192 if off target anddecreased when the subject 192 is on target. The saliency may beincreased when the subject 192 if off target, decreased when on target;the rate of change is proportionate to the size and duration of subjecterror.

Additionally, the duration of testing may be controlled by the size andduration of subject error. More particularly, sustained, stable scoresmay lead to earlier termination of testing. Multiple oscillations ofscores around a stable level may lead to termination. The inability tocapture the target at any saliency may lead to termination.

Further, exemplary sensory-motor neurocognitive assessment responsecharacterization protocols may be initiated using configurationsinformed by previous tests. Visuo-motor response parameters, such as themaximum speed, maximum acceleration, minimum reversal interval, may beestablished in a particular test and then used as standards insubsequent tests. Further, visual contrast sensitivity measures may bedetermined and used in subsequent tests to provide each subject 192 withindividually standardized stimuli in later tests. Further, sensory-motorneurocognitive assessment visual processing measures may be used forcomparison to adjust scores in attentional and memory manipulationssuperimposed on those tests.

Further, another embodiment of the present disclosure may be to operatea system for quantitative assessment of functional impairment withminimal intervention. The present disclosure may include artificialintelligence capability to enable dynamic testing. Further, each test ofthe present disclosure may include an ability to dynamically respond toactions of subject 192. Thus, each test in the present disclosure mayshorten or lengthen itself automatically in response to the actionstaken by the subject 192.

In one embodiment, ten tests may be administered to assess functionalimpairment of the subject 192. Further, in one embodiment, the tests maybe administered in the order described below. However, the methods inaccordance with the embodiments of the present disclosure may includethe performance of any other subset of the ten tests which may beadministered in any order. Further, the tests may encompass present andfuture known equivalents to the known components referred to herein byway of illustration.

FIG. 25 illustrates the initiation of the dynamic contrast test, whichevaluates visuo-motor responses by analysis of the sensori-cognito-motorfunction in the domains of target movement speed, acceleration, anddirection reversal. A patch of high contrast may be comprised ofindividual elements, which includes, but is not limited to, circles,checkerboard, or stripes. The individual elements, herein called dots,may be equally displaced to either high or low luminance levels and maybe distinguished from intermediate luminance background elements.

The starting phase of the dynamic contrast test 1300 may initiatemovement of a high color/contrast patch onto the stimulus area 199. Anequal number of darker-contrast dots 1304 and lighter-contrast dots 1306may be presented within a neutral-contrast background stimulus area1308, which may be surrounded by the circular border 1302. Thedarker-contrast dots 1304 and lighter-contrast dots 1306 may be randomlyassigned in size in the range of three degrees or smaller, therebymaintaining a pink noise spatial frequency composition of dots acrossthe screen. A high color/contrast patch, which may be an active stimulusradial segment 1310, which may move onto the stimulus area 199. Theactive radial segment 1310, which may be a twenty-five degrees sectionwithin the circular border 1302, may contain a number of relativelyhigher contrast level darker dots 1312 and relatively lower contrastlevel lighter dots 1314.

The darker-contrast dots 1304 and lighter-contrast dots 1306 fade in andout in the neutral-contrast background stimulus area 1308 with randomlyassigned life time periods that are chosen within a timed interval. Anoperator 190 may pre-set the brightness level of the neutral-contrastbackground stimulus area 1308, the number of darker-contrast dots 1304and lighter-contrast dots 1306 within the circular border 1302, therelative color of the of the neutral-contrast background stimulus area1308 relative to the color of the darker-contrast dots 1304 andlighter-contrast dots 1306, and the maximum diameter of thedarker-contrast dots 1304 and lighter-contrast dots 1306.

A stimulus generator 450 supplies an algorithm that may be applied torelatively higher contrast level darker dots 1312 and relatively lowercontrast level lighter dots 1314 within the active stimulus radialsegment 1310, which may make the relatively higher contrast level darkerdots 1312 achieve a relatively higher contrast level compared to thedots in the neutral-contrast background stimulus area 1308 and therelatively lower contrast level lighter dots 1314 achieve a relativelylower contrast level compared to the dots in the neutral-contrastbackground stimulus area 1308.

The operator 190 may pre-set settings for the active stimulus radialsegment 1310, the brightness level of the active stimulus radial segment1310, the number of relatively higher contrast level darker dots 1312and relatively lower contrast level lighter dots 1314 within the activestimulus radial segment 1310, the relative color of the of the activestimulus radial segment 1310 relative to the color of relatively highercontrast level darker dots 1312 and relatively lower contrast levellighter dots 1314, and the maximum diameter of the relatively highercontrast level darker dots 1312 and relatively lower contrast levellighter dots 1314.

During the starting phase of the dynamic contrast test 1300, the activestimulus radial segment 1310 may generate the highest contrast level forthe relatively higher contrast level darker dots 1312 and the lightestcontrast level for the relatively lower contrast level lighter dots 1314within the active stimulus radial segment 1310. Then, the activestimulus radial segment 1310 may begin to move continuously, and whiledoing so, the active stimulus radial segment 1310 may direction ineither a clockwise or counterclockwise direction and/or it canaccelerate or decelerate.

The subject 192 may be asked to identify and to parallel the movement ofthe active stimulus radial segment 1310 using an subject manipulandum1402 during the starting phase of the dynamic contrast test 1300. Thesubject's control and movement of an subject manipulandum 1402 may betracked on the subject display 198 with a cursor 1050. The activestimulus radial segment 1310 may be tracked with the cursor 1050 via thesubject's control.

As the active stimulus radial segment 1310 moves around theneutral-contrast background stimulus area 1308, the contrast levelwithin the active stimulus radial segment 1310 may begin to change alongwith the location, direction, and speed of the active stimulus radialsegment 1310. As the contrast level of the active stimulus radialsegment 1310 begins to decline, the subject 192 will find it to be moredifficult to follow the movements of the active stimulus radial segment1310. Therefore, the operator 190 may gauge an approximate threshold forthe relative contrast level of the active stimulus radial segment 1310that the user can decipher.

FIG. 26 shows the intermediate phase of the dynamic contrast module test1320, a phase marked by a discontinuous nature. During thisdiscontinuous phase, the active stimulus radial segment 1310 may moveabout in a discontinuous fashion, beginning with fade-out stage of a lowcontrast level for the active stimulus radial segment 1310 at a levelequal to or lower than the initial contrast level of the starting phaseof the dynamic contrast test 1300.

During this fade-out period, the active stimulus radial segment 1310 mayfade-out initially. Subsequently, the active stimulus radial segment1310 may fade-in with the relatively higher contrast level darker dots1312 and relatively lower contrast level lighter dots 1314 within theactive stimulus radial segment 1310 being recreated in contrastconditions according to original randomization conditions; however, therecreated relatively higher contrast level darker dots 1312 andrelatively lower contrast level lighter dots 1314 are moved, via amotion herein analogous to a jumping motion, to a new location withinthe neutral-contrast background stimulus area 1308, which is filled withdarker-contrast dots 1304 and lighter-contrast dots 306 and may also besurrounded by the circular border 1302.

Whenever the subject 192 moves the subject manipulandum 402, the cursor1050 may track the target active stimulus radial segment 1310; if thesubject 192 can successfully track the target active stimulus radialsegment 1310 within a predetermined limit, an instant bright flash andbeep may signal and may confirm the action of the subject 192. Theintermediate phase of the dynamic contrast test 1320 may continue withfurther jumps until the operator 190 develops a further refinedthreshold; subsequent restarting of the intermediate phase of thedynamic contrast test 1320 may continue at varying levels of contrastand rates of contrast increase, resulting in a repeat process until anensuing threshold may be attained.

FIG. 27 illustrates the termination phase of the dynamic contrast test1322, during which the subject 192 may no longer distinguish thepresence of an active stimulus radial segment 1310 within theneutral-contrast background stimulus area 1308. At this point, the finallocation of the cursor 1050 may mark the critical threshold, for whichthe data of the threshold in used in the ensuing tests. Immediatelyfollowing the critical threshold point, the darker-contrast dots 1304and lighter-contrast dots 1306 may fill the entire the neutral-contrastbackground stimulus area 1308, which may be surrounded by the circularborder 1302.

FIG. 28 depicts the starting phase of the visual contrast sensitivitytest 1324, which may involve the implementation of a patch of highluminance elements 1325 onto an active stimulus radial segment 1310,which may be within the circular border 1302. The patch of highluminance elements 1325 may include, but are not limited, to beingcircles, checkerboard, or stripes. The individual elements may bedistinguished from intermediate luminance background elements to varysaliency. The subject 192 controls the position and movement of a cursor1050 to match that of the target.

During the starting phase of the visual contrast sensitivity test 1324,high luminance elements 1325 may be distinguished from thedarker-contrast dots 1304 and lighter-contrast dots 1306 that may berandomly assigned in the neutral-contrast background stimulus area 1308.

FIG. 29 depicts the intermediate phase of the visual contrastsensitivity test 1326. The high luminance elements 1325 may beautomatically transitioned to becoming low luminance, thereby becominglow luminance elements 1327, during the intermediate phase of the visualcontrast sensitivity test 1325. The transition to becoming low luminanceelements 1327 may enable the subject 192 to determine the threshold.

FIG. 30 illustrates the termination phase of the visual contrastsensitivity test 1328, during which the subject 192 may be presentedwith both a mixed luminance elements, comprising both high luminanceelements 1325 and low luminance elements 1327, within the activestimulus radial segment 1310. During the process of the stimulus radialsegment 1310 gradually presenting a mixed luminance, the subject 192 maybe cued to determine the threshold to achieve an equal number of highluminance elements 1325 and low luminance elements 1327 within theactive stimulus radial segment 1310. At the point when the subject 192may determine an equal number of high luminance elements 1325 and lowluminance elements 1327, the final location of the cursor 1050 may markthe critical threshold, for which the data of the threshold in used inthe ensuing tests.

FIG. 31 depicts the initiation of the visual form discrimination test,during which patches of regular shapes may be distorted to distinguishtarget area shapes from their background. During the visual formdiscrimination test, patches of regular shapes may be distorted todistinguish the target area shapes from the background. The patches ofregular shape may be distorted in a manner including, but not limitedto, size, shape, aspect ratio, line thickness, and/or orientation. Thesubject 192 may control the position and movement of cursor 1050 tomatch that of the target.

During the starting phase of the visual form discrimination test 1330,an equal number of darker-contrast rectangles 1332 and lighter-contrastrectangles 1334 may be presented within a neutral-contrast backgroundstimulus area 1308, which may be surrounded by the circular border 1302.The darker-contrast rectangles 1332 and lighter-contrast rectangles 1334may be randomly assigned in sizes of one unit length width and threeunit lengths height across the screen. An active visual form modulestimulus radial segment 1336, which may be a twenty-five degrees sectionwithin the circular border 1302, contains a number of relatively highercontrast level darker rectangles 1332 and relatively lower contrastlevel lighter rectangles 1334.

An operator 190 may pre-set the brightness level of the neutral-contrastbackground stimulus area 1308, the number of darker-contrast rectangles1332 and lighter-contrast rectangles 1334 within the circular border1302, the relative color of the of the neutral-contrast backgroundstimulus area 1308 relative to the color of the darker-contrastrectangles 1332 and lighter-contrast rectangles 1334, and the maximumdiameter of the darker-contrast dots 1304 and lighter-contrast dots1306.

The darker-contrast rectangles 1332 and lighter-contrast rectangles 1334may fade in and out in the neutral-contrast background stimulus area1308 with assigned life time periods that may chosen within a timedinterval set between thirty-six and one-hundred eight frames atseventy-two frames per second with emergence and fading occurring overthree frames. Further, the darker-contrast rectangles 1332 andlighter-contrast rectangles 1334 may fade in and out in theneutral-contrast background stimulus area 1308 while moving to randomnew positions.

The subject 192 may be asked to identify the active visual form modulestimulus radial segment 1336 using a manipulandum 402, during thestarting phase of the visual form discrimination test 1330. Thesubject's control and movement of a subject manipulandum 402 may betracked on the subject display 198 with a cursor 1050. The active visualform module stimulus radial segment 1336 may be tracked with the cursor1050 via the subject's control.

FIG. 32 displays the intermediate phase of the visual formdiscrimination test 1340, a phase marked by a discontinuous nature.During this discontinuous phase, the rectangular elements within theactive visual form module stimulus radial segment 1336 may vary in size,shape, and orientation while the active visual form module stimulusradial segment 1336 moves continuously around the circular border 1302with varying levels of distinctiveness. More particularly, the activevisual form module stimulus radial segment 1336 may move continuouslyaround the circular border 1302 while accelerating or deceleratingand/or moving clockwise or counterclockwise; furthermore, therectangular elements within the active visual form module stimulusradial segment 1336 may change direction of movement from clockwise tocounterclockwise or vice-a-versa.

The subject 192 may be asked to parallel the movement of the activevisual form module stimulus radial segment 1336 using a cursor 1050,which a may be physical interface akin to a wheel or a joystick, duringthe intermediate phase of the visual form module test 1340.Subsequently, the active visual form module stimulus radial segment 1336fades-in with the relatively higher contrast level darker rectangles1332 and relatively lower contrast level lighter rectangles 1334 withinthe active visual form module stimulus radial segment 1336 beingrecreated in contrast conditions according to original randomizationconditions; however, the recreated relatively higher contrast leveldarker rectangles 1332 and relatively lower contrast level lighterrectangles 1334 may be moved, via a motion herein analogous to a jumpingmotion, to a new location within the neutral-contrast backgroundstimulus area 1308.

Whenever the subject 192 moves the cursor 1050 into the target activestimulus radial segment 1310, an instant bright flash and beep maysignal and may confirm the action of the subject 192. The intermediatephase of the visual form module test 1340 may continue with furtherjumps until the operator 190 develops a further refined threshold;subsequent restarting of the intermediate phase of the intermediatephase of the visual form module test 1340 may continue at varying levelsof contrast and rates of contrast increase, resulting in a repeatprocess until an ensuing threshold is attained.

FIG. 33 illustrates the termination phase of the dynamic contrastdiscrimination test 1348, during which the subject 192 may no longerdistinguish the presence of the active visual form module stimulusradial segment 1336 within the neutral-contrast background stimulus area1308. Hence, the darker-contrast rectangles 1332 and lighter-contrastrectangles 1334 may fill the entire the neutral-contrast backgroundstimulus area 1308, which may be surrounded by the circular border 1302.At this point, the final location of the cursor 1050 may mark thecritical threshold, for which the data of the threshold may be used inthe ensuing tests.

FIG. 34 depicts the initiation of the visual motion discrimination test,during which spots move in a direction or create a motion defined edgeor a point. The subject 192 may control the position and movement of acursor 1050 to match of the target. During the visual motiondiscrimination test, the salience of the target may be decreased byshifting more elements to random motion.

The starting phase of the visual motion discrimination test 1350 mayinclude segmental presentations of a radial center of motion in opticflow. An equal number of darker-contrast dots 1304 and lighter-contrastdots 1306 may be presented within a neutral-contrast background stimulusarea 1308, which may be surrounded by the circular border 1302. Thecontrast levels for the darker-contrast dots 1304 and lighter-contrastdots 1306 may be set two confidence intervals above the thresholdestablished in the starting phase of the dynamic contrast test 1300. Thedarker-contrast dots 1304 and lighter-contrast dots 1306 may move in anoutward radial pattern 1354 by moving away from a focus of expansion1352, which may be a designated point within the circular border 1302.

More particularly, the focus of expansion, or the focus of contractionthat may be created by inward directed movement 1352 may be locatedanywhere within the circular border; however the eccentricity of thefocus of expansion 1352 may be pre-set. Further, the darker-contrastdots 1304 and lighter-contrast dots 1306 may be randomly assigned insize in the range of three degrees or smaller, thereby maintaining apink noise spatial frequency composition of dots across the screen.Moreover, the control variables may include background brightnessneutral-contrast background stimulus area 1308 and dot density, color,spatial frequency, and speed of the darker-contrast dots 1304 andlighter-contrast dots 1306. The ratio of dots that may be movingradially outwards to the number of total dots may be known as thecoherence ratio. Of note, the ratio may be full coherence, with a ratioof one to one, or no coherence, with a ratio of zero to one.

The darker-contrast dots 1304 and lighter-contrast dots 1306 may fadeand emerge with a random lifespan between thirty-six and seventy-twoframes with three frames for emergence and three frames for fading. Thespeed of the darker-contrast dots 1304 and lighter-contrast dots 1306may be a sin² function of the angular distance from the focus ofexpansion 1352. The starting phase of the visual motion discriminationtest 1350 may begin with full coherence where the subject 192 can allpoints moving in a outward radial pattern 1354 away from the singularpoint known as the focus of expansion 1352.

FIG. 35 shows the intermediate phase of the visual motion discriminationtest 1360, a phase during which the focus of expansion 1352 may movewith varying movements of coherence, location, direction, and speed. Thedarker-contrast dots 1304 and lighter-contrast dots 1306 may move in anoutward radial pattern 1354 or in a random fashion 1356 from a frame toanother frame. The subject's cursor identification is a twenty-fivedegree radial segment, such that the subject 192 may need to move thecursor 1050 so that the focus of expansion 1352 falls within thetwenty-five degree segment.

When the subject 192 moves the cursor 1050 to enter the twenty-givedegree segment, then the intermediate phase of the visual motiondiscrimination test 1360 may produce a bright flash and beep. Startingwith a low level of coherence, the focus of expansion 1352 may begin tomove in a discontinuous, jumping motion around the circular border 1302with each fade and emergence sequence; with each such jump, thecoherence level increases.

FIG. 36 illustrates the termination phase of the visual motiondiscrimination test 1370, during which the subject 192 may no longerdistinguish the presence of the twenty-five degree segment that may beassociated with the focus of expansion 1352. Hence, the darker-contrastdots 1304 and lighter-contrast dots 1306 may fill the entire theneutral-contrast background stimulus area 1308, which may be surroundedby the circular border 1302. At this point, the final location of thecursor 1050 may mark the critical threshold, for which the data of thethreshold in used in the ensuing tests. Ultimately, this threshold maybe achieved by successively constraining the starting coherence and therate of increase.

With reference to FIGS. 34, 35, and 36, may include, but is not limitedto, presentations of a radial center of motion in optic flow, which mayinclude the focus of expansion 1352 in the stimulus area 199. Futureequivalents of the present subject matter may present a uniform simpleplanar translational motion stimulus, wherein the subject 192 may orienta cursor 1050, which may include, but is not limited to a ball-and-stickcursor, in the direction of motion. Further, future equivalents of thepresent subject matter may present a circular pattern of motion with thecenter of rotation moving around the stimulus area 199 just as the focusof expansion 1352 may move around in a radial optic flow field. Further,the circular and radial stimuli may be summed to create a spiral inwhich the center of the spiral may move around the stimulus area 199.

FIG. 37 depicts the superposition of form and motion tests, hereincalled the spatial distractor tasks test, to assess the combination ofvisual motion and visual form. The subject 192 may control the positionand movement of cursor 1050 to match that of the target, while form,motion, or other basic stimuli are combined with brief visual orauditory distracters to interfere with the task.

The starting phase of the spatial distractor tasks test 1380 may includethe superimposed darker-contrast rectangles 1332 and lighter-contrastrectangles 1334 from the starting phase of the visual formdiscrimination test 1330 in FIG. 31 together with relatively highercontrast level darker dots 1312 and relatively lower contrast levellighter dots 1314 within the active stimulus radial segment 1310 fromthe starting phase of the dynamic contrast test 1300 in FIG. 25.

The number of darker-contrast rectangles 1332 and lighter-contrastrectangles 1334 in the starting phase of the spatial distractor taskstest 1380 may be one-half of the number of the equivalent structures ofthe starting phase of the visual form discrimination test 1330. Thenumber of relatively higher contrast level darker dots 1312 andrelatively lower contrast level lighter dots 1314 within the activestimulus radial segment 1310 may be one-half of the number of theequivalent structures of in the starting phase of the dynamic contrasttest 1300. Hence, both patterns may be shown are one-half of the cueelement density than previously with the starting phase of the visualform discrimination test 1330 and the starting phase of the dynamiccontrast test 1300 respectively.

Additionally, the darker-contrast rectangles 1332 and lighter-contrastrectangles 1334 in the starting phase of the spatial distractor taskstest 1380 have distinction levels set between two confidence levelsbelow and above the established threshold for distinctiveness from thetermination phase of the dynamic contrast discrimination test 1348 ofFIG. 33. As described in great detail in the detailed description of thestarting phase of the visual form discrimination test 1330, thedarker-contrast rectangles 1332 and lighter-contrast rectangles 1334 mayfade in and out in the neutral-contrast background stimulus area 1308while moving to random new positions.

Additionally, relatively higher contrast level darker dots 1312 andrelatively lower contrast level lighter dots 1314 within the activestimulus radial segment 1310 in the starting phase of the spatialdistractor tasks test 1380 have coherence levels set between twoconfidence intervals below and above the established threshold forcoherence from the termination phase of the dynamic contrast test 1322in FIG. 27. As described in great detail in the detailed description ofthe starting phase of the visual form discrimination test 1330,relatively higher contrast level darker dots 1312 and relatively lowercontrast level lighter dots 1314 within the active stimulus radialsegment 1310 may fade in and out in the neutral-contrast backgroundstimulus area 1308 with randomly assigned life time periods that arechosen within a timed interval.

Further, the active stimulus radial segment 1310 may undergo the samesequence of settings and conditions outlined by the algorithm of thestimulus generator 450 as described in great detail in the startingphase of the visual form discrimination test 1330. Meanwhile, auditorydistracters or other basic stimuli may interfere with the task, whichmay be associated with dual task interference. Further, dual taskinterference may require the subject to align one target area on top ofanother target area. Further, the subject may need to utilize twofunctions of its brain, which may cause interference amongst those brainfunctions.

FIG. 38 illustrates the intermediate phase of the spatial distractortasks test 1390, a phase during which the focus of expansion 1352 moveswith varying movements of coherence, location, direction, and speedoutlined by the detailed description of the intermediate phase of thevisual motion discrimination test 1360 in FIG. 35. The variations withthe focus of expansion 1352 may be superimposed with active stimulusradial segment 1310 described in detail in the starting phase of thespatial distractor tasks test 1380 of FIG. 37. This superimposition oftasks may test the subject's cognitive processing ability while thesubject 192 must utilize two functions of its brain, wherein thefunctions may interfere with each other.

In order to ensure that the subject 192 understands the complexity ofthe superimposed test iteration present in the intermediate phase of thespatial distractor tasks test 1390, the first continuous movement may beperformed at two confidence intervals above the threshold established intermination phase of the dynamic contrast module test 1322 and twoconfidence intervals below the threshold established in the terminationphase of the dynamic contrast discrimination test 1348. Subsequently,the continuous movement may be performed at two confidence intervalsabove the threshold established in termination phase of the dynamiccontrast module test 1322 and two confidence intervals below thethreshold established in the termination phase of the dynamic contrastdiscrimination test 1348.

The subject's control and movement of a subject manipulandum 402 may beimplemented to track to the form target and the motion target onto thesubject display 198 with the use of a cursor 1050. The form target andthe motion target locations may be separated by a predeterminedseparation distance within the range of one-hundred fifty degrees andtwo-hundred ten degrees.

The subject 192 may use the cursor 1050 to track form target, whichincludes the form changes of the darker-contrast rectangles 1332 andlighter-contrast rectangles 1334. The subject 192 may use the cursor1050 to track motion of motion target, which includes the relativelyhigher contrast level darker dots 1312 and relatively lower contrastlevel lighter dots 1314. Further, the cursor 1050 may also beimplemented to track the motion and to track the form in the respectivetests of FIGS. 39, 40, and 41 as outlined in greater detail in theaccompanying descriptions of those respective figures.

After a pre-selected limit, the two stimuli of motion and form shiftplaces in the paradigm and the subject 192 may be instructed to shifttasks.

FIG. 39 represents the left-up form target and right-up motion target ofthe visual motion and visual form attention test 1400. Both the patternsof darker-contrast rectangles 1332 and lighter-contrast rectangles 1334and relatively higher contrast level darker dots 1312 and relativelylower contrast level lighter dots 1314 within the active stimulus radialsegment 1310 may be superimposed during phase 1400.

FIG. 40 displays the left-up form, low-distinct target and right-upmotion, high-coherence target of the visual motion and visual formattention test 1410. Both the patterns of darker-contrast rectangles1332 and lighter-contrast rectangles 1334 and relatively higher contrastlevel darker dots 1312 and relatively lower contrast level lighter dots1314 within the active stimulus radial segment 1310 may be superimposedduring the phase of the left-up form, low-distinct target and right-upmotion, high-coherence target of the visual motion and visual formattention test 1410.

FIG. 41 shows the left-up form, high-distinct target and right-upmotion, low-coherence target of the visual motion and visual formattention test 1420. Both the patterns of darker-contrast rectangles1332 and lighter-contrast rectangles 1334 and relatively higher contrastlevel darker dots 1312 and relatively lower contrast level lighter dots1314 within the active stimulus radial segment 1310 may be superimposedduring the phase of the left-up form, high-distinct target and right-upmotion, low-coherence target of the visual motion and visual formattention test 1420.

FIG. 42 portrays the left-up form, high-distinct target and right-upmotion, high-coherence target of the visual motion and visual formattention test 1430. Both the patterns of darker-contrast rectangles1332 and lighter-contrast rectangles 1334 and relatively higher contrastlevel darker dots 1312 and relatively lower contrast level lighter dots1314 within the active stimulus radial segment 1310 may be superimposedduring the phase of the left-up form, high-distinct target and right-upmotion, high-coherence target of the visual motion and visual formattention test 1330.

Further, the spatial distractor tasks testing of the subject matterregarding FIGS. 37, 38, 39, 40, 41, and 42, may be added to any test ofthe present disclosure. The radial optic flow stimulus may be thesubstrate for the spatial distractor tasks testing; however any otherfunctional assessment test may be associated with the stimulus for thesubstrate of the spatial distractor tasks testing. The presentdisclosure describes a subject 192 that is performing a spatialdiscrimination task and may position the cursor 1050, which may be aball-and-stick cursor, at the location on the stimulus area 199 wherethe subject 192 sees a high saliency wedge within the stimulus area 199.The present disclosure may superimpose the intermittent addition of analternative, high saliency cue somewhere else, such that the subject 192may transiently shift attention to that distractor so that thedistractor is not task relevant and also not to degrade the targetfollowing in the main task. The distractor may include, but is notlimited to, a wedge of unique stimulus elements flashing for one tothree seconds at a position far from the target wedge, an area of uniqueelements flashing on for one to three seconds at a position far from thetarget edge, or the transient displacement of the cursor 1050 to someplace other than that specified by the subject 192.

Further, the spatial distractor tasks testing of the subject matterregarding FIGS. 37, 38, 39, 40, 41, and 42, may be associated withspatial memory testing, in which the spatial memory of a subject 192 maybe used to augment the subject's response sensitivity in any of the maintasks, which may include, but it not limited to, form, motion, andwords. In these main tasks, the target wedge may transiently flash tosome high saliency cue, which may include, but it not limited to onehundred percent saliency of the target cue, or all white, or all black,and then may revert to its near threshold saliency and makes astereotyped movement or selected number of movements. After repeatedexposures, the subject 192 may implicitly, that is without being told,acquire knowledge of the flashes' meaning. The subject 192 may use thatinformation to enhance the ability to follow the target stimulus throughthat spatial sequence; for instance, the subject 192 may further usemovement as a stimulus for learning a sequence of movements. Further,spatial memory testing may include, but is not limited to sequencememory or location memory. Further, spatial memory testing may be acombination of testing associated with sequence memory and locationmemory.

FIG. 43 displays the starting phase of the letter identification latencymodule 1440, during which equal numbers of alternating black-coloredletter sets 1442 and white-colored letter sets 1444 may be presented ina fixed sequence around the edge of circular, stimulus area 1446. Thethree letters words may be distributed in the background, which maycomprise a cluster of other three letter sets and also a real word thatdefines a target. Further, a word may be associated with correct lettersthat may be imbedded in a stimulus ring with three letter figures madeof non-letters.

The three letters for the alternating black-colored letter sets 1442 andwhite-colored letter sets 1444 may fall into the following categoriesof: 1) target word, 2) legal-non-words, 3) illegal non-words, 4) flippedillegal non-words, and 5) flipped and rotated non-word. The threeletters may be in different orientations or may utilize false fonts asfurther outlined in FIGS. 44, 45, and 46.

Font, size, and position of the black-colored letter sets 1442 andwhite-colored letter sets 1444 may be determined by the pre-sets fromthe starting phase of the visual motion discrimination test 1350 and thestarting phase of the visual form discrimination test 1330. The contrastof the letters may be set at being two confidence intervals above thesubject's contrast threshold obtained in the termination phase of thevisual motion discrimination test 1370.

FIG. 44 shows normal letters orientation 1450, which may be appliedtowards the three letters that were described previously in the startingphase of the letter identification latency module 1440 of FIG. 43.

FIG. 45 shows mirror rotated letters orientation 1454, which may beapplied towards the three letters that were described previously in thestarting phase of the letter identification latency module 1440 of FIG.43.

FIG. 46 shows inverted letters orientation 1458, which may be appliedtowards the three letters that were described previously in the startingphase of the letter identification latency module 1440 of FIG. 43.

FIG. 47 shows the intermediate phase of the letter identificationlatency module 1460, during which the three letters of the black-coloredletter sets 1442 and white-colored letter sets 1444, which may be withinthe circular stimulus area 1446, may be partially obscured to reducetheir saliency and to establish the cursor tracking response function.During the start of the test paradigm of the intermediate phase of theletter identification latency module 1460, the subject 192 may bepresented with the highest level of letter continuity. A plurality ofthe item stimulus may set drift around the stimulus area 199, which maybe a ring, in unison. The subject 192 may move the cursor 1050 to thereal word and follow it for a predetermined time period or apredetermined extent as angular degrees of drift. The score may bederived from the time it takes the subject 192 to register the locationof the real word that may be captured and tracked.

Subsequently, word continuity may be continually and algorithmicallydisrupted by the superimposition of background color line segments thatocclude a set percentage of the length of the line segments forming thecharacters in the display. The subject 192 may be asked to follow theletter sets using the cursor 1050 during the continuous movement of theletter sets around the around the edge of circular stimulus area 1446.

The letter sets in the array may drift in unison around the displaycircle or may emerge and fade to take-up new positions on the screenwith a full field random cycle length in a settable range, which may betypically thirty six to one-hundred eight frames at seventy-two hertzwith emergence and fading each occurring over three frames. The positionand continuity of the letter sets may be subjected to the algorithmiccontrol of the stimulus generator 450. Each position shift may triggerthe transition of all character sets to other specific example of eachset type in the corresponding relative positions.

In an alternate embodiment of the intermediate phase of the letteridentification latency module 1460, a word may be made of correctletters imbedded within the stimulus area 199, which may be a ring, withother similar length, correct letter, non-words. All of the three-letteritems may drift around the ring in unison. The subject 192 may move thecursor 1050 to the real word and follow it for a predetermined timeperiod or a predetermined angular degrees of drift. The score may bederived from the time it takes the subject 192 to register the locationof the real word that may be captured and tracked.

In yet another embodiment of the intermediate phase of the letteridentification latency module 1460, correct letter words may be imbeddedin the stimulus area 199, which may be a ring, with other similarlength, correct letter, non-words. All of the three-letter items mydrift around the ring in unison. The content of the ring, which mayrefer to its real words and non-words, my change regularly as thecontent drifts so there is always a wedge, which may be a ring segment,containing real words and the remainder of the ring contains non-words.Further, as the subject 192 moves the cursor 1050 to the real word andfollows it for some predetermined time period or a predetermined angulardegrees of drift, the saliency of all of the letters of the words andnon-words may be slowly decreased. The saliency may be decreased eitherby crossing-out parts of all of the letters with a background coloredset of thin lines, or by rotating the individual letters, or by coveringthe ring with flickering letter-colored dots. The subject 192 maycontinue to find the real words as algorithmic adjusting of the saliencydetermines that subject's threshold saliency. The score is derived fromthe saliency level as described for the other tests of the presentdisclosure.

FIG. 48 shows the termination phase of the letter identification latencymodule 1470, during which an approximate threshold may be defined. Thereremains continuous movement of the target character set and subjecttracking during continuous varying of the continuity and exchange of allcharacter sets across cycles towards the end of intermediate phase ofthe letter identification latency module 1460.

Later, during the termination phase of the letter identification latencymodule 1470, while in discontinuous movement, the target segment mayfade to the background parameters and then may emerge at a new locationwhere it may undergo increasing continuity until the subject's cursormay enter the target segment area. Immediately thereafter, there may bean instantaneous bright flash and beep. Subsequent iterations of thistrial may yield a refined threshold.

FIG. 49 illustrates the starting phase of the verbal memory module 1480.This test paradigm may present a series of words 1482 in a list to bememorized. The sample consists of a series of words 1482 that may bearranged around the edge of the stimulus area 199 and headed by thelabel “Words might be” 1484. The sample words are positioned at selectedlocations with selected light and dark luminances. During the startingphase of the verbal memory module 1480, the subject 192 may be presenteda predetermined series of short words, each with a predetermined numberof letters in a set sequence.

FIG. 50 displays the intermediate phase of the verbal memory module1490. The subject 192 may track the target word in the series of words1482, starting form low saliency and successively becoming more salient,via the presentation of sample and match across contrast stimuli 1492. Aparticular word in a series of words 1482 may be presented one-at-a-timealong with words not on the list. In other words, in this series ofstimuli, the word target may be either sample words or not.

During the intermediate phase of the verbal memory module 1490, thesubject 192 may be first shown a series of ten high contrast black orwhite words for a pre-set adjustable time period, which may be for fiveseconds. The subject 192 may then be shown a series of the same type ofstimuli that may have been used in the starting phase of the letteridentification latency module 1440 as was shown in FIG. 43. Thepresentation of sample and match across contrast stimuli 1492, which maybe implemented in the intermediate phase of the verbal memory module1490, may be the same fade-jump-emerge contrast modulation sequence thatmay have been used in the intermediate phase of the letteridentification latency module 1460.

In an alternate embodiment of the intermediate phase of the verbalmemory module 1490, the target word from a predetermined ordered listmay be presented at very low saliency after each presentation of apredetermined series of short words. That target word from apredetermined ordered list may drift around the stimulus ring imbeddedin with other drifting three-letter sets that are not words. While thesubject 192 remains off target, the saliency of the word and the threeletter non-words may slowly increase until the word is recognizable asthe only word on the screen. The subject 192 may move the cursor 1050,which may be a ball-stick cursor, to the target word and follow it forsome predetermined time period or a predetermined degrees of angularmovement to register correct acquisition. When the subject 192 hascorrectly identified the target word, the score for that trial isrecorded as the current saliency level. Then, the next word from thelist may be imbedded in a new set of three letter non-words at very lowsaliency and the task continues. The cycle of first viewing the listpresentation of these predetermined list of words and then testing onfinding the words at the lowest saliency possible may be repeated threetimes. Scoring of the test may include the number of words correctlyacquired, the saliency level at which they were acquired, and the slopeof the average saliency levels across the three repetitions of the task.

In yet another embodiment of the intermediate phase of the verbal memorymodule 1490, only one target word may be implemented. In this exemplaryembodiment, after the saliency score is calculated, the number of targetwords may be slowly increased to repeatedly derive that subject'ssaliency threshold as the word list length increases. If one knows theword one is looking for, then it may be relatively easy to find it;however, the degree of difficulty may increase with an increase in thenumber of words. Each subject 192 may have a function of saliency versuslist length and that may be a measure of verbal memory's ability toenhance word recognition.

In an alternate embodiment of the intermediate phase of the verbalmemory module 1490, may include, but is not limited to, a ring with onlycorrect letter words. As the subject 192 correctly follows the initiallysingle word around the ring, another word will be added and the subject192 may shift to following the new word. Throughout the test, new wordsmay be added and may be monitored for how long it takes the subject 192to identify and shift to the new word most recently added to the subjectdisplay 198. Scoring may be accomplished by measuring the new wordidentification latency, as a function of the total number of words inthe display during that response.

The responses to the stimuli from the intermediate phase of the verbalmemory module 1490 may be used to establish response dynamics in thestimulus contrast domain and the kinematics domain. During theintermediate phase of the verbal memory module 1490, the targetorientation may be placed towards the left or towards the right of thestimulus area 199, and may be either high, moderate, or low contrast.FIGS. 51, 52, and 53 show the various placement configurations andcontrast conditions that may be implemented during the intermediatephase of the verbal memory module 1490.

With reference to FIGS. 51, 52, and 53, equal numbers of alternatingblack-colored symbol sets 1502 and white-colored symbol sets 1504 may bepresented in a fixed sequence around the edge of circular stimulus area1446. The three letters symbol sets may be distributed in the backgroundthat may comprise a cluster of other three letter symbol sets and also areal word that defines the target.

The three symbols for the alternating black-colored symbol sets 1502 andwhite-colored symbol sets 1504 may include, but are not limited to,symbols, target words, legal-non-words, illegal non-words, flippedillegal non-words, flipped and rotated non-words. Further, the threeletters symbol sets may be in any orientation. Further, the font, size,and position of the black-colored symbol sets 1502 and white-coloredletter symbol sets 1504 may be determined by the pre-sets from thestarting phase of the visual motion discrimination test 1350 and thestarting phase of the visual form discrimination test 1330. The contrastof the black-colored symbol sets 1502 and white-colored letter symbolsets 1504 may be set at being two confidence intervals above thesubject's contrast threshold obtained in the termination phase of thevisual motion discrimination test 1370.

More particularly, FIG. 51 illustrates the left-up target orientationwith black-colored symbol sets 1502 and white-colored symbol sets 1504in high contrast. FIG. 52 shows the right-up target orientation withblack-colored symbol sets 1502 and white-colored symbol sets 1504 inmoderate contrast. FIG. 53 displays the right-down target orientationwith black-colored symbol sets 1502 and white-colored symbol sets 1504in low contrast.

With reference to FIGS. 54, 55, and 56, facial emotion sensitivity testsmay be presented to the subject 192. More particularly, FIG. 54 shows alow difficulty facial emotion sensitivity test 1530, FIG. 55 shows amoderate difficulty facial emotion sensitivity test 1540, and FIG. 56shows a high difficulty facial emotion sensitivity test 1550, for any ofwhich a display of faces 1532 may be presented to the subject 192. Aplurality of faces, may be all of the same person or may be apseudo-person composite of other faces.

Subsequently, the affective emotion may be modulated, such as fromgrimace or frown to a wide-eyed or smile emotion. There may be agradient of emotion expressions distributed across the faces, from happyfaces at one point to sad faces one hundred eighty degrees from thatpoint. The subject 192 may locate and may track the happiest face or thesaddest face. The subject 192 may be asked to use the subjectmanipulandum 1402 to point to the happier faces as the differencesbetween the happier and sadder faces may be narrowed with goodperformance or widened with poor performance. The subject 192 maydemonstrate a minimal difference in affective expression required fortheir identifying the most positive or happy expression. The subject 192may use the rotatory manipulandum 414 to rotate and to align the cursor1050 to the happiest face 1538 as the range from sad to happy isincreased, thereby making task easier, or decreased, thereby making taskharder. The subject 192 may rotate the rotatory manipulandum 414 in aclockwise rotation 1534 or in a counterclockwise rotation 1536.

The algorithm associated with the present disclosure may alter the rangeof faces, which may be from very happy to very sad. The algorithmassociated with the present disclosure may alter the range of faces,which may be slightly happy to slightly sad. The mid-point may be fromhappy to neutral, or in an alternative embodiment may be from neutral tosad. Further, the algorithm associated with the present disclosure maybe easy or difficult. Further, the subject's score may be a reflectionof the minimal range, which may be of greatest difficulty, at which thesubject 192 may accurately locate and track the target.

The low difficulty facial emotion sensitivity test 1530, moderatedifficulty facial emotion sensitivity test 1540, and high difficultyfacial emotion sensitivity test 1550 differ in the level of difficultywithin each test. Further, the low difficulty facial emotion sensitivitytest 1530, moderate difficulty facial emotion sensitivity test 1540, andhigh difficulty facial emotion sensitivity test 1550 may help determinethe test subject's perceptual threshold range scored relative to anormal range derived from comparison subject groups. Facial gender, age,and identity may be randomly shifted during intervals of the testsession. Future known equivalents of the low difficulty facial emotionsensitivity test 1530, moderate difficulty facial emotion sensitivitytest 1540, and high difficulty facial emotion sensitivity test 1550 mayuse only one gender, age, etc. facial identity group or can usealternative target, which may include, but is not limited to, thesaddest face.

With reference to FIGS. 57, 58, and 59, facial emotion nulling tests maybe presented to the subject 192. More particularly, FIG. 57 shows a lowdifficulty facial emotion nulling test 1570, FIG. 58 shows a moderatedifficulty facial emotion nulling test 1580, and FIG. 59 shows a highdifficulty facial emotion nulling test 1590, for any of which a displayof a particular facial expression 1572 is presented to the subject 192.

During either the low difficulty facial emotion nulling test 1570,moderate difficulty facial emotion nulling test 1580, or a highdifficulty facial emotion nulling test 1590, a single image of a samegender face is presented and the system varies the affective expressionof the face from a sadder to a happier expression and vice-a-versa.

The emotional expression of the single face may be varied as describedin the low difficulty facial emotion sensitivity test 1530, moderatedifficulty facial emotion sensitivity test 1540, and high difficultyfacial emotion sensitivity test 1550. During either the low difficultyfacial emotion nulling test 1570, moderate difficulty facial emotionnulling test 1580, or a high difficulty facial emotion nulling test1590, the subject 192 may uses the subject manipulandum 402 to make theface appear neutral, which may refer to being neither happy nor sad. Thesubject 192 may be asked to rotate the rotary manipulandum 414 withcounter-clockwise rotation 1534, thereby making the expression sadderwith the use of the turn to make sadder feature 1576, or with clockwiserotation, thereby making the expression happier with the use of the turnto make happier feature 1574.

The goal of the subject 192 may be to continue to rotate the rotarymanipulandum 414 to make the expression neutral as the presentdisclosure makes sustained changes in the affective expression of thefacial display. The subject 192 may use the rotatory manipulandum 414 tomorphologically transform facial expression across the spectrum fromsadder, which may be through repeated counterclockwise rotation 1536, tohappier, which may be through repeated clockwise rotation 1534, to keepthe facial expression neutral.

The algorithm of the present disclosure may continually shift theemotional content of the facial expression and the subject 192 may haveto change it back toward neutral. Such a test may be associated withbeing a nulling task, wherein only the parameter is changed, and thesubject 192 has to perceive the direction and magnitude of the changeand set it back to where it was. The scoring may reflect the magnitudeof change required to trigger the subject's response, the point calledneutral from happy and the point called neutral from sad.

The low difficulty facial emotion nulling test 1570, moderate difficultyfacial emotion nulling test 1580, or a high difficulty facial emotionnulling test 1590 each may be sixty to one-hundred eighty seconds induration. The system repeatedly may drift the facial expression to asadder or to a happier condition as the subject 192 may try to null thateffect and may try maintain a neutral expression on the display. Thesystem may use an adaptive staircase protocol to determine the smallestperturbation of facial expression that may provoke an appropriatecounter-response from the test subject 192 as a facial expressionperceptual threshold, which may be scored relative to normal rangeidentifiable by others in the comparison subject group.

Facial gender, age, and identity may be randomly shifted duringintervals of the test session. Future known equivalents of the lowdifficulty facial emotion nulling test 1570, moderate difficulty facialemotion nulling test 1580, or a high difficulty facial emotion nullingtest 1590 may use only one gender, age, etc.

Further, the low difficulty facial emotion nulling test 1570, moderatedifficulty facial emotion nulling test 1580, or a high difficulty facialemotion nulling test 1590 each differ in the level of difficulty withineach test.

With reference to FIGS. 60, 61, and 62, social cues sensitivity testsmay be presented to the subject 192. More particularly, FIG. 60illustrates the low difficulty social cues sensitivity test 1610, FIG.61 illustrates the moderate difficulty social cues sensitivity test1620, and FIG. 62 illustrates the high difficulty social cuessensitivity test 1630, for each of which a display of varyingaggressiveness levels 1612 may be presented to the subject.

In one embodiment, the display of varying aggressiveness levels 1612 mayshow a number of whole body images of different persons. The subject 192may use the rotatory manipulandum 414 to align the cursor 1050 to theimage of the person being most aggressive, herein called the mostaggressive person 1614. The subject 192 may rotate the rotatorymanipulandum 414 in a clockwise rotation 1534 or in a counterclockwiserotation 1536 to indicate the most aggressive person 1614 on the displayof varying aggressiveness levels 1612. As the range from submissive toaggressive is increased, thereby making the task easier, or decreased,thereby making the task harder, the perceptual threshold of the subject192 relative to a normal range may be characterized in comparison.

In an alternate embodiment, a variety of different body positionalattributes may be displayed. For example, the body positional attributemay be associated with the most/least worried or the most/leastfrightened or the most/least leadership ability or the most/leastassertive. The body positional attribute of least worried may beassociated with, but is not limited to, smiling, titled head andshoulders, and hands at the side. The body positional attribute of mostworried may be associated with, but is not limited to, pursed-lips,slouched head and shoulders, and hands tightly clasped in front of thelower face. The body positional attribute of most frightened may beassociated with, but is not limited to, eyes bulging, limbs flexed, andjerky movements. The body positional attribute of least frightened maybe associated with, but is not limited to, smiling, upright, and slowmovements.

Person gender, age, and identity may be randomly shifted duringintervals of the test session for any or all of the low difficultysocial cues sensitivity test 1610, the moderate difficulty social cuessensitivity test 1620, or the high difficulty social cues sensitivitytest 1630. Future known equivalents of any or all of the low difficultysocial cues sensitivity test 1610, the moderate difficulty social cuessensitivity test 1620, or the high difficulty social cues sensitivitytest 1630 may use only one gender, age, etc. postural identity group orcan use alternative target features, which may include, but is notlimited to, the most submissive person.

Further, the low difficulty social cues sensitivity test 1610, themoderate difficulty social cues sensitivity test 1620, or the highdifficulty social cues sensitivity test 1630 may also consider theinteractions between the persons depicted in the display of varyingaggressiveness levels 1612 such that the subject 192 indicates who maybe the most likely to be leader of the group. The subject 192 may changethe cursor 1050 to indicate who they see as the likely leader withdifferences between target leaders' traits and those of the person leastlikely to assume leadership are successively changed.

Further, the low difficulty social cues sensitivity test 1610, themoderate difficulty social cues sensitivity test 1620, or the highdifficulty social cues sensitivity test 1630 each differ in the level ofdifficulty within each test.

In an alternative embodiment of social perception domain testing,nulling adjustments may be evaluated in the social interactions nullingtest, which may include, but is not limited to, a full bodyrepresentation of two people standing side-by-side in an ongoing socialinteraction. One person may stand on the left side and another personmay stand on the right side. One person may be a man, and the otherperson may be a woman; alternatively, both persons may be of the samesex. Further, one person may be of a particular ethnic background;another person may be of a different ethnic background; alternatively,both persons may be of the same ethnic background. During socialinteractions nulling testing, postures, facial expressions, and/orgestures may be distinctive among the two people; however, the twopersons may not interact with words. The subject 192 may be instructedto adjust the left or right person to make one more dominant and thealgorithm will change the balance, thereby making nulling adjustments.

With reference to FIGS. 63, 64, and 65, typical target traces arepresented, which may be, but are not limited to, sixty seconds traces.FIG. 63 shows an exemplary position trace 1650. FIG. 64 illustrates anexemplary speed trace 1660. FIG. 65 depicts an exemplary accelerationtrace 1670.

The exemplary position trace 1650, the exemplary speed trace 1660, andthe exemplary acceleration trace 1670 may show the target location,which may be driven in a tracking fashion by the stimulus generator 450or in discontinuous fashion by jumping movements. Further, the exemplaryposition trace 1650, the exemplary speed trace 1660, and the exemplaryacceleration trace 1670 may show initially, the highest signal-to-noisestimuli that may trigger the subject capture, which may refer to thepositioning near the center of the highest signal-to-noise segment.

The exemplary tests of the present disclosure capture may be followed byirregular tracking movements with graded signal-to-noise fade-emergecycles that may trigger capture cycles. Further, the exemplary tests ofthe present disclosure capture may include increasing, then decreasing,position and velocity error. During the exemplary tests of the presentdisclosure, escape, which may refer to gradually increasing error, maytrigger either: 1) fixed-position re-emergence to trigger re-capture andthen continuing movement, or 2) full-fading, jump to a new site, andre-emergence there until re-capture triggers new tracking movements.Further, uniformity of the distribution of capture position may beassisted by jumps and movement parameters may during signal-to-noise(S/N) fading cycles that may be based on subject error.

With reference to FIG. 66, an exemplary 3D S/N Gradient 1680, whereinS/N may refer to signal-to-noise ration, is presented. The exemplary 3DS/N Gradient 1680 may be representative of being across all stimulusdomains. The exemplary tests of the present disclosure may beimplemented to achieve a three-fold signal-to-noise gradient. Moreparticularly, during the exemplary tests of the present disclosure, fromthe point furthest from the target in the stimulus area 199, there maybe a gradual increase to one-third of the current peak signal-to-noiseratio at the edges of the target segment, which may be a thirty degreessegment. Further, another one-third signal-to-noise ratio increase mayextend from the thirty degrees edges to a ten degrees segment in thestimulus area 199. The exemplary tests of the present disclosure may bestructured such that the peak signal-to-noise should extend uniformlyacross the ten degrees segment, which may result in the hypothetical 3DS/N Gradient 1680.

With reference to FIG. 67 an exemplary S/N profile 1690 with respect tovertical and horizontal positions is presented. The an exemplary S/Nprofile 1690 may be reflective of subject 192 response analyses thatindicate the subject 192 may accurately track to yield reliableperformance across all domains. Such reliable performance may beachieved via following of recommendations, which may be, but is notlimited to:

i) The first stimulus cycles of each test of the present disclosure maybe at low motion parameters and high signal-to-noise ratios so that thesubject 192 may understand the task.

ii) Motor performance may be established by imposing a series ofmovement acceleration-deceleration cycles or direction reversal cyclesin at least two of the four quadrants of the hypothetical S/N profile1690.

iii) Subsequent cycles may include cue fading, which may result fromdecreasing the signal-to-noise ratio, such that when the cue escapes,the motion may slow in order to see whether the subject 192 may reducethe error distance. If the subject 192 catches-up, then the slower speedmay become the new base speed. However, if error reduction does notoccur, then the target slows down to a stop and the signal-to-noiseratio is increased until re-capture triggers the resumption of movement.

iv) There may be a jump to a new position near the current responseposition by slowly increasing the signal-to-noise ratio.

v) Repeated test cycles may be used to refine the impression of thesignal-to-noise threshold and fastest speed and acceleration that thesubject may accurately track to yield reliable performance across allconditions.

FIG. 68 shows an exemplary position error function profile 1700, whichmay be a plot of error by signal-to-noise to describe the performance ofthe subject 192. A graph of the position error axis 1701 versus thesignal-to-noise percentage axis 1703 that may be present in the positionerror function profile 1700. The position error maximum 1702 and theposition error minimum 1705 may be asymptotic projections, which maycapture the best and the worst performance of the subject 192. Theposition error peak slope 1706 may be the mid point in the range of plusor minus five percent of the highest slope. The position error area 1704under the curve of the position error function profile 1700 may describethe overall performance of the subject 192. Further, the position errorfunction profile 1700 may be qualitatively grouped into profiles basedon degree of differences, such as being good, fair, and poor.

FIG. 69 shows an exemplary sampled position error function profile 1710,which may be a plot of the position error axis 1701 versus thesignal-to-noise percentage axis 1703, on a sampled basis. The exemplarysampled position error function profile 1710 may be based on a thresholdand a variance measure from the tests of the present disclosure. Forinstance, in the visual motion discrimination test, which is furtherdescribed in FIGS. 34, 35, and 36, the threshold is taken to be thesignal-to-noise ratio under the point on the sampled position errorfunction profile 1710 that is two position error significant digits backon along the sampled position error function profile 1710 curve. Thepresent disclosure may utilize the range of the signal-to-noise coveredby the two position error significant digit steps as a variancemeasures. The measures that may be implemented in the position errorfunction profile 1700 and the sampled position error function profile1710 may be sensitive to best performance, capture escape variability,and the local slope of the position error curve.

FIG. 70 displays an exemplary velocity error function profile 1720,which may be a plot of the velocity error axis 1708 versus thesignal-to-noise percentage axis 1703. The velocity error functionprofile 1720 may show a representation of the difference between thestimulus and the response velocity.

FIG. 71 portrays the instantaneous position error 1800 of the subject192. The subject error 1802 may be a function of the subject position1804, the angular error 1806, and the target position 1808. The subjecterror 1802 may be an error in the selection of the target on thestimulus area 199 by the subject 192. The subject position 1804 may bean error in the position of the target on the stimulus area 199 by thesubject 192. The angular error 1806 may be an error in the angularposition of the target on the stimulus area 199 by the subject 192.

FIG. 72 shows a graphical representation of the error magnitudethroughout test 1850, which may be a plot of the position error indegrees 1852 versus the time from the start of this test 808, which maybe represented as ten seconds intervals 806. Further, the graph theerror magnitude throughout test 1850 may represent increasing positionalerror 1854 with a higher value of time from the start of this test 808.Further, the graph the error magnitude throughout test 1850 mayrepresent decreasing positional error 1854 with a lower value of timefrom the start of this test 808.

Further, the error associated with the error magnitude throughout test1850 may peak at an escape event, during which a subject 192 may losetrack of the target, but may decrease when the subject 192 re-capturesthe target to successively converge on subject's typical error margin.The error may be signed as being plus or minus one-hundred and eightydegrees relative to the direction of target movement, with the subject192 being ahead or behind that movement.

FIG. 73 depicts the stimulus obscuration over time 1950, which may referto the task difficulty over time. More particularly, the graph ofstimulus obscuration over time 1956 may be a graph of percentagestimulus obscuration 1952 versus time since start of test module in thissession 1954. Further, the time since start of test module in thissession 1954 may be represented, but is not limited to, as being fiveseconds intervals.

FIG. 74 displays the subject position error relative to target position1960. The subject position error relative to target position 1960 may bea graph of subject position error over time 1962, which may berepresented as a graph of position error in degrees 1964 versus timesince start of test module in this session 1954. Further, the time sincestart of test module in this session 1954 may be represented, but is notlimited to, as being five seconds intervals.

FIG. 75 illustrates depicts the subject velocity error relative totarget velocity 1970. More particularly, the graph of subject velocityerror relative to target velocity 1972 may be graphically represented assubject minus target as percent maximum 1974 versus time since start oftest module in this session 1954. Further, the time since start of testmodule in this session 1954 may be represented as subject minus targetas percent maximum versus but is not limited to, as being five secondsintervals.

FIG. 76 shows a results summary 2000 via a graphical user interface,which may be based on the results from the tests of the presentdisclosure. The results summary may include, but is not limited to, arepresentation of the quantitative assessment of language processing2002, verbal memory 2004, motion perception 2006, shape perception 2008,contrast sensitivity 2010, and spatial attention 2012. The resultssummary 2000 may aid in determining a quantitative score andinterpretation of passing or failing in relation to functionalimpairment. More particularly, the sensory-motor neurocognitiveassessment associated with the results summary 2000 may result incharacterization protocols that may yield response functions relatingtime and saliency that may generate real-time scores based on: theaverage final saliency score over three periods, the saliency at whichthe most time may be spent during testing, and the total time that maybe spent in the test.

Additional scoring may be achieved off-line and may focus on analgorithmic fit of an asymptotic function to the response functiongenerated in each sensory-motor neurocognitive assessment protocol. Thisfunction may then be used to describe performance and generate secondarymeasures, which may include, but are not limited to: 1) basic measuressuch as the fit parameters, asymptote and area under the curve, 2)comparative measures as the differences between the basic measures of asubject on a particular sensory-motor neurocognitive assessment protocoland that subject from other selected sensory-motor neurocognitiveassessment protocols, 3) comparative measures as the differences betweenthe basic measures of a subject on a test and the measures from aselected group of comparison subjects.

Sensory-motor neurocognitive assessment measures associated with theresults summary 2000 may be derived in real-time for each test and maybe transformed as standardized scores relative to an age-basedcomparison group. These standardized scores may be derived separatelyfor each sensory-motor neurocognitive assessment protocol.

Sensory-motor neurocognitive assessment protocol scores associated withthe results summary 2000 may be shown on a radial plot, grouped bycognitive relatedness sensory-motor neurocognitive assessments.Differences between age-normal function and a test subject's functionmay be colored in particular color to indicate sub-normal function andcolored in a different color to indicate supernormal function.Differences that may be induced by the negative impact of invalid cuesand the positive impact of valid cues may be shown as closely relatedfunctions.

Further, differences between a subject's function and age-normalfunction may be inferred from observed differences in sensory-motorneurocognitive assessments for that subject 192 and the average ofsubjects in the same age range. Differences in excess of two standarddeviations of the average for that age group may be interpreted as beingsubstantial. Substantial impairments may be taken to suggest someunderlying pathophysiology. Specific patterns of impairments acrosssensory-motor neurocognitive assessments may be associated with specificpathophysiologies.

FIG. 77 provides an exemplary recommended diagnosis summary 2050, whichmay include a clinical diagnosis and/or a recommendation medicationslisting. The recommended diagnosis summary 2050 may include, but is notlimited to, a functional impairment characteristic profile 2052 and arecommended diagnosis 2054. The functional impairment characteristicprofile 2052 may be shown graphically on a plot of the rating of thefunctional impairment characteristic versus the calendar time range2056. More particularly, the scale for the rating of the functionalimpairment characteristic of the functional impairment characteristicprofile 2052 may range from normal for age 2060 to more impaired 2062.

In summary, the present disclosure teaches a method, system, andtangible computer readable medium for addressing quantitative assessmentof functional impairment in a subject. An apparatus for quantifyingassessment of functional impairment in a subject comprising an inputdevice, a display device, a control device, and a tangible computerreadable medium. A hierarchical system of functional impairment teststhat quantitatively measures the response characteristics of the brainin the subject.

The present disclosure is applicable towards neurological diagnostics,ophthalmological diagnostics, psychiatric diagnostics, medical andsurgical diagnostics, disease progression monitoring, treatmentmonitoring, side-effects monitoring, human developmental applications,human performance in educational applications, public healthassessments, human performance assessment related to social analysis,insurance evaluations, human resources evaluations, task readinessassessments, animal health and research, coupling with genomics,coupling with neuroimaging, coupling with neurophysiology, coupling withneurochemistry, and coupling with basic science research.

More particularly and with regards towards neurological diagnostics, thepresent disclosure may be applicable towards diagnosis of diseases anddisorders affecting perception, behavior, and cognition. Further, thepresent disclosure may be applicable towards the early detection anddiagnosis of dementias related to Alzheimer's disease and its precursorssyndromes that include mild cognitive impairment and age-associatedmemory impairment and other diagnostic sub-types of related pathologies.

Further, the present disclosure may be applicable towards the earlydetection and diagnosis of fronto-temporal dementias and precursorsyndromes and sub-syndromes that include frontal lobar, temporal lobar,and Pick's dementias and other diagnostic sub-types of relatedpathologies.

Further, the present disclosure may be applicable towards the earlydetection and diagnosis of Parkinsonism, and its precursors syndromesand related disorders that include Parkinsonian dementias and othermovement disorders in the rigid-bradykinetic syndromic spectrum andrelated pathologies.

Further, the present disclosure may be applicable towards the earlydetection and diagnosis of cerebrovascular disorders with centralmanifestations of overt stroke or of the manifestations of thetransient, sub-acute, or chronic abnormal perfusion of brain tissue.

Further, the present disclosure may be applicable towards the earlydetection and diagnosis of the neurological manifestations of exposureto toxic substances including poisons, combustion products, andenvironmental hazards and extremes including chemicals and radiation.

Further, the present disclosure may be applicable towards the earlydetection and diagnosis of the neurological manifestations of changes inendogenous or artificial hormones resulting from natural progressionthrough the life-cycle or from therapeutic or iatrogenic changes inhormonal effects.

Further, the present disclosure may be applicable towards the earlydetection and diagnosis of neurological disorders in young peopleincluding attention deficit disorders, hyperactivity disorders, anddisorders of specific functional or learning impairments.

More particularly and with regards towards ophthalmological diagnostics,the present disclosure may be applicable towards the diagnosis ofophthalmological diseases and disorders. Further, the present disclosuremay be applicable towards the early detection and diagnosis of oculardisease and their precursors syndromes that include disorders of thecornea, lens, and vitreous and their supportive tissues in the eye.

Further, the present disclosure may be applicable towards the earlydetection and diagnosis of disorders of aqueous fluid dynamics, such asglaucoma, and related disorders of intrinsic, traumatic, or iatrogenicetiology affecting aqueous generation, passage, or resorption.

Further, the present disclosure may be applicable towards the earlydetection and diagnosis of disorders of the retina and its supportivetissues including exposures to toxins and radiation, inherited disordersof the retina, trauma to the retina, and deformations of retinalstructure or function.

Further, the present disclosure may be applicable towards the earlydetection and diagnosis of disorders of the pathways leading from theeye and to the brain centers responsible for processing visual signals.

Further, the present disclosure may be applicable towards the earlydetection and diagnosis of disorders of the brain centers, nerves, andmuscles responsible for stably maintaining the position and movement ofthe eye that result in the ability to control gaze direction andconjugacy.

More particularly and with regards towards psychiatric diagnostics, thepresent disclosure may be applicable towards the early detection anddiagnosis of affective disease and their precursors syndromes thatinclude major depression, bipolar illnesses, and the affectivemanifestations of other psychiatric disorders.

Further, the present disclosure may be applicable towards the earlydetection and diagnosis of disorders of psychotic disorders that includepsychiatric disorders in the spectrum of schizophrenia as well aspsychotic disorders that are the result of other illnesses, acute orchronic.

Further, the present disclosure may be applicable towards the earlydetection and diagnosis of disorders in the spectrum of autism,Asperger's, and Williams syndromes and related psychiatric disorderscaused by inherited or non-inherited genetic disorders and early lifemis- or mal-formations.

More particularly and with regards towards medical and surgicaldiagnostics, the present disclosure may be applicable towards thediagnosis of functional complications of medical and surgical disorders,such as with the early detection and diagnosis of functionalcomplications of cardiopulmonary disease including those that result inthe hypoperfusion and hypo-oxygenation of the brain in an acute,sub-acute, or chronic, temporary or permanent manner.

Further, the present disclosure may be applicable towards the earlydetection and diagnosis of functional complications of urinary-renal orgastrointestinal disorders including conditions that alter theabsorption, accumulation, metabolism, or elimination of endogenous orexogenous toxins.

Further, the present disclosure may be applicable towards the earlydetection and diagnosis of functional complications of closed orpenetrating head trauma in an acute, sub-acute, or chronic, temporary orpermanent manner.

Further, the present disclosure may be applicable towards the earlydetection and diagnosis of functional complications of surgicalprocedures that alter brain function directly or indirectly in an acute,sub-acute, or chronic, temporary or permanent manner.

Further, the present disclosure may be applicable towards the earlydetection and diagnosis of functional complications of anesthesiologicalprocedures that alter brain function directly or indirectly in an acute,sub-acute, or chronic, temporary or permanent manner.

More particularly and with regards towards disease progressionmonitoring, the present disclosure may be applicable towards thequalitative or quantitative monitoring of the regression, stabilization,or progression of functional disorders as a consequence of changes inthe pathophysiology causing those functional disorders.

More particularly and with regards towards treatment monitoring, thepresent disclosure may be applicable towards the qualitative orquantitative monitoring of the improvement, stabilization, or lack ofimprovement or stabilization in functional disorders as a consequence oftherapeutic interventions.

More particularly and with regards towards side-effects monitoring, thepresent disclosure may be applicable towards the declines in function asthe result of interventional side-effects that would includeside-effects of neuro-active and non-neuro-active treatments that mayconstitute common, or idiosyncratic reactions.

More particularly and with regards towards human developmentalapplications, the present disclosure may be applicable towards thequalitative or quantitative assessment of human development in a medicalor educational setting to determine an individual's development status,further development, or departure from expected patterns and rates ofdevelopment either across functional domains or with limited functionaldomains.

More particularly and with regards towards human performance ineducational applications, the present disclosure may be applicabletowards the qualitative or quantitative assessment of human performancein an educational setting to determine an individual's suitability foran educational program or need for alternatives, and of therapeutic orother exogenous factors' influence on suitability for educationalprograms.

More particularly and with regards towards public health assessments,the present disclosure may be applicable towards the qualitative orquantitative assessment of human performance in the setting of publichealth to monitor the health of select or broadly defined groups, andfor comparisons across groups undergoing treatments, exposures, or otherfactors that may impact on human performance.

More particularly and with regards towards human performance assessmentrelated to social analysis, the present disclosure may be applicabletowards qualitative or quantitative assessment of human performance inthe setting of efforts to understand differences between sociallydefined or socially recognized populations reflecting endogenousdifferences or the impact of exogenous factors such as stress, culturalchanges, or other events.

More particularly and with regards towards insurance evaluations, thepresent disclosure may be applicable towards the qualitative orquantitative assessment of human functional capacities as an indicationof their risk of developing impairments, and as an indication of theirneed for access to medical or other resources.

More particularly and with regards towards human resources evaluations,the present disclosure may be applicable towards the qualitative orquantitative assessment of human performance in the setting of humanresources evaluations related to hiring individuals well-suited tospecific tasks.

More particularly and with regards towards task readiness assessments,the present disclosure may be applicable towards the qualitative orquantitative assessment of human performance in the setting of readinessto perform critical tasks that might be subject to endogenous orexogenous variation in readiness to perform that task, these wouldinclude the effects of sleep status and therapeutic or non-therapeuticmedicines or other exposures.

More particularly and with regards towards animal health and research,the present disclosure may be applicable towards the qualitative orquantitative assessment of an animal's functional capacities in manycontexts that include: assessment of an animal's functional health or ofa group of animal's health in the context of veterinary medical orveterinary population health applications, assessment of the impact ofpotentially therapeutic interventions on an animal's functional health,either in the context of a veterinary medical application or forevaluations of interventions for potential human applications, orassessment of a toxic exposure on an animal's functional health, eitherin the context of a veterinary medical application or for evaluations ofthe potential consequences of human exposures.

More particularly and with regards towards coupling with genomics, thepresent disclosure may be applicable towards the qualitative orquantitative assessment of human performance in relation to molecular orchemical analyses of human differences and their relationship toperformance including analyses of chemical and genetic factors that mayinfluence performance in isolation or in combination with other factors.

More particularly and with regards towards coupling with neuroimaging,the present disclosure may be applicable towards the qualitative orquantitative assessment of human performance in the setting oftechnologically mediated assessments of brain structure and function byimaging modalities including, but not limited to, the analysis ofnormal, variant, or pathological anatomy or physiology by radiologicalimaging, magnetic imaging, radioactive isotope imaging, and thermalimaging.

More particularly and with regards towards coupling withneurophysiology, the present disclosure may be applicable towards thequalitative or quantitative assessment of human performance in thesetting of technologically mediated assessments of brain structure andfunction by electrical or magnetic field measurements of normal,variant, or pathological anatomy or physiology by resting or activatedactivity.

More particularly and with regards towards coupling with neurochemistry,the present disclosure may be applicable towards the qualitative orquantitative assessment of human performance in the setting oftechnologically mediated assessments of brain chemistry and metabolismby direct sampling of brain or other neural tissue, samplingcerebrospinal fluid, or sampling of other bodily fluids or derivatives.

More particularly and with regards towards coupling with basic scienceresearch, the present disclosure may be applicable towards thequalitative or quantitative human performance in the context of basicscientific research on the subject of human performance or on othersubjects in which human performance relations are relevant.

All references, including publications, patent applications, andpatents, cited herein are hereby incorporated by reference to the sameextent as if each reference were individually and specifically indicatedto be incorporated by reference and were set forth in its entiretyherein.

The methods and process flows of the disclosed subject matter that areassociated with the computer readable medium may be described in thegeneral context of computer-executable instructions, such as programmodules, being executed by a computer. Generally, program modulesinclude routines, programs, objects, components, data structures, etc.that performs particular tasks or implement particular abstract datatypes. The disclosed subject matter may also be practiced in distributedcomputing environments wherein tasks are performed by remote processingdevices that are linked through a communications network. In adistributed computing environment, program modules may be located inlocal and/or remote computer storage media including memory storagedevices.

The detailed description set forth below in connection with the appendeddrawings is intended as a description of exemplary embodiments in whichthe presently disclosed process can be practiced. The term “exemplary”used throughout this description means “serving as an example, instance,or illustration,” and should not necessarily be construed as preferredor advantageous over other embodiments.

The detailed description includes specific details for providing athorough understanding of the presently disclosed method and system.However, it will be apparent to those skilled in the art that thepresently disclosed process may be practiced without these specificdetails. In some instances, well-known structures and devices are shownin block diagram form in order to avoid obscuring the concepts of thepresently disclosed method and system.

The foregoing description of the disclosed embodiments is provided toenable any person skilled in the art to make or use the claimed subjectmatter. Various modifications to these embodiments will be readilyapparent to those skilled in the art, and the generic principles definedherein may be applied to other embodiments without the use of theinnovative faculty. Thus, the claimed subject matter is not intended tobe limited to the embodiments shown herein but is to be accorded thewidest scope consistent with the principles and novel features disclosedherein. It is contemplated that additional embodiments are within thespirit and true scope of this disclosed method and system as claimedbelow.

What is claimed is:
 1. A method for assessment of visual contrastsensitivity of a subject, said method comprising the steps of:presenting at least one scene to said subject on a display, said scenecomprising a plurality of elements and a background; modulating thecontrast of at least one said element, said contrast being differentfrom that of said background; receiving feedback from said subject viaat least one input device; quantitatively refining said receivedfeedback relative to said scene; adjusting said contrast relative toaccuracy of said quantitatively refined feedback; calculating a criticalthreshold parameter for said subject; and recording said criticalthreshold parameter onto a tangible computer readable medium.
 2. Themethod of claim 1, further comprising at least one of the additionalsteps of: monitoring at least one response error from said subject; andmeasuring said response error relative to a predetermined threshold. 3.The method of claim 1, wherein said predetermined threshold furthercomprises an equal number of high luminance elements and low luminanceelements.
 4. The method of claim 1, wherein said plurality of elementsfurther comprises a plurality of contrast values.
 5. The method of claim1, wherein said plurality of elements comprises at least one of thefollowing: plurality of circles; and plurality of rectangles.
 6. Themethod of claim 1, wherein said modulated contrast is displaced higherthan that of said background.
 7. The method of claim 1, wherein saidmodulated contrast is displaced lower than that of said background. 8.The method of claim 6, wherein said displaced contrast is equally higheramong said plurality of elements.
 9. The method of claim 7, wherein saiddisplaced contrast is equally lower among said plurality of elements.10. The method of claim 1, wherein said adjusted contrast is displacedhigher than that of said background.
 11. The method of claim 1, whereinsaid adjusted contrast is displaced lower than that of said background.12. The method of claim 1, wherein said quantitative refinement isassociated with saliency.
 13. The method of claim 1, wherein saidplurality of elements further comprises a plurality of colors.
 14. Themethod of claim 1, wherein said critical threshold parameter isimplemented in a different functional impairment assessment test.
 15. Anapparatus for quantitative assessment of visual contrast sensitivity ofa subject comprising: a display for presenting at least one scenecomprising a plurality of elements and a background; an input device fortracking movement from said subject; a control device, said controldevice capable of performing the following steps: modulating thecontrast of at least one said element, said contrast being differentfrom that of said background; receiving feedback from said subject viaat least one input device; quantitatively refining said receivedfeedback relative to said scene; adjusting said contrast relative toaccuracy of said quantitatively refined feedback; calculating a criticalthreshold parameter for said subject; and recording said criticalthreshold parameter onto a tangible computer readable medium; and atangible computer readable medium for recording said critical thresholdparameter.
 16. The apparatus of claim 15, wherein said display presentsat least one contrast variation in said background.
 17. The apparatus ofclaim 15, wherein said display presents at least one contrast variationamong said plurality of elements.
 18. The apparatus of claim 15, whereinsaid control device monitors at least one the response error fromsubject.
 19. The apparatus of claim 15, wherein said control devicemeasures at least one response error relative to a predeterminedthreshold.
 20. A tangible non-transitory computer readable medium, saidtangible non-transitory computer readable medium containing instructionscomprising the steps of: presenting at least one scene to said subjecton a display, said scene comprising a plurality of elements and abackground; modulating the contrast of at least one said element, saidcontrast being different from that of said background; receivingfeedback from said subject via at least one input device; quantitativelyrefining said received feedback relative to said scene; adjusting saidcontrast relative to accuracy of said quantitatively refined feedback;and calculating a critical threshold parameter for said subject.